Sherlyta Revania Ranuh


Background: Tubercular meningitis in children poses a diagnostic challenge, either for its detection and follow-up. Neuroimaging is essential in the diagnosis process and early identification of complication or sequelae. Computed tomography (CT) scan is widely available in secondary and tertiary hospitals in Indonesia, which would improve the management of paediatric tubercular meningitis case.
Objective: To describe the clinical progression of a child with tubercular meningitis from detection to sequelae at Bethesda Hospital, Yogyakarta.
Case description: A 7-year-old boy was admitted to the emergency unit with acute headache, vomiting, and prolonged fever. Tuberculosis transmission indicated from the mother, which on TB treatment. Non-contrast multi-sliced computed tomography (MSCT) scan was performed on the first-day admission, on the 8th day of admission, before and after VP-shunt procedure for life-threatening hydrocephalus and the follow-up. There was an obvious disease progression shown by CT scan from the early stage, the onset of hydrocephalus, deteriorating hydrocephalus, and post-VP-shunt procedure. The periventricular infarct extended over time, concordant with worsening symptoms.
Conclusion: Paediatric tubercular meningitis diagnosis relies on accurate neuroimaging studies to identify the specific sign. In the disease progression, the sign as early as slight hyperdensity should lead to meningitis diagnosis, and earlier treatment of hydrocephalus might prevent further debilitating sequelae or even fatal complications of tubercular meningitis.


meningeal tuberculosis, child, multidetector computed tomography, hydrocephalus

Full Text:



Situasi TBC di Indonesia – TBC Indonesia [Internet]. [cited 2020 Mar 1]. Available from:

World Health Organisation. Guidance for national tuberculosis programmes on the management of tuberculosis in children. 2nd ed. Geneva; 2014.

Wasay M, Farooq S, Khowaja ZA, Bawa ZA, Ali SM, Awan S, et al. Cerebral infarction and tuberculoma in central nervous system tuberculosis: frequency and prognostic implications. J Neurol Neurosurg Psychiatry. 2014 Nov 1;85(11):1260–4.

Asik, Endang Budi Hastuti, Yullita Evarini Yuzwar, editors. Petunjuk Teknis Manajemen dan Tatalaksana TB Anak [Internet]. Jakarta: Kementerian Kesehatan RI; 2016.

Taheri MS, Karimi MA, Haghighatkhah H, Pourghorban R, Samadian M, Kasmaei HD. Central Nervous System Tuberculosis: An Imaging-Focused Review of a Reemerging Disease. Radiol Res Pract [Internet]. 2015;2015:202806.

Török ME. Tuberculous meningitis: advances in diagnosis and treatment. Br Med Bull. 2015 Mar 1;113(1):117–31.

Principi N, Esposito S. Diagnosis and therapy of tuberculous meningitis in children. Tuberculosis. 2012 Sep 1;92(5):377–83.

Thwaites GE, Toorn R van, Schoeman J. Tuberculous meningitis: more questions, still too few answers. Lancet Neurol. 2013 Oct 1;12(10):999–1010.

Walker V, Selby G, Wacogne I. Does neonatal BCG vaccination protect against tuberculous meningitis? Arch Dis Child. 2006 Sep 1;91(9):789–91.

Botha H, Ackerman C, Candy S, Carr JA, Griffith-Richards S, Bateman KJ. Reliability and Diagnostic Performance of CT Imaging Criteria in the Diagnosis of Tuberculous Meningitis. PLOS ONE. 2012 Jun 29;7(6):e38982.

Patkar D, Narang J, Yanamandala R, Lawande M, Shah GV. Central Nervous System Tuberculosis: Pathophysiology and Imaging Findings. Neuroimaging Clin N Am. 2012 Nov 1;22(4):677–705.

Bernaerts A, Vanhoenacker FM, Parizel PM, Van Goethem JWM, van Altena R, Laridon A, et al. Tuberculosis of the central nervous system: overview of neuroradiological findings. Eur Radiol. 2003 Aug 1;13(8):1876–90.

Jamil O, Kestle JRW, H. Richard Winn. Hydrocephalus in Children: Etiology and Overall Management. In: Youmans and Winn Neurological Surgery [Internet]. 7th ed. Philadelphia, PA: Elsevier; 2017 [cited 2020 Jul 19]. p. 1588-1594.e2.

Aulakh R, Chopra S. Pediatric tubercular meningitis: A review. J Pediatr Neurosci. 2018;13(4):373.



  • There are currently no refbacks.

Copyright (c) 2020 Berkala Ilmiah Kedokteran Duta Wacana

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.