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Tuberculous Meningitis — SCE Neurology MCQ

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HardCNS InfectionsTuberculous MeningitisSCE Neurology

A 46-year-old recently arrived from Bangladesh has six weeks of headache, fever and cognitive slowing. MRI shows basal meningeal enhancement and small infarcts. CSF has 180 lymphocytes/µL, protein 1.9 g/L and glucose 1.6 mmol/L; rapid molecular testing is negative. What is the best next step?

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Correct answer: C — Start four-drug antituberculous treatment plus adjunctive corticosteroids

The subacute course, epidemiology, low CSF glucose, basal enhancement and perforator infarcts make tuberculous meningitis highly likely. NICE advises treatment when the clinical and laboratory picture is consistent even if rapid testing is negative, using standard four-drug induction and an adjunctive corticosteroid tapered over 4–8 weeks. The alternative regimens target acute pyogenic, viral or cryptococcal patterns and culture delay risks irreversible neurological injury.

Reference: NICE NG33 tuberculosis: recommendations (Updated February 2024): https://www.nice.org.uk/guidance/ng33/chapter/Recommendations