CASE HISTORY

Patient had whooping cough at the age of six weeks and also had convulsions two months before admission, but apart from this was apparently healthy until two weeks before admission when she complained of pain in the right side and vomiting. She was restless, peevish and constipated, and for the last few days before admission had vomited everything. There was a family history of contact with tuberculosis. The child’s brother was known to be tuberculous and was in very close contact with her. On examination, the child was poorly nourished and languid. Lungs, heart and abdomen showed no physical signs. There was no marked neck rigidity and no Kernig's sign. The following day she was fretful and showed very slight head retraction, but still no kernig's sign and no physical signs in the chest. Lumbar puncture performed: CSF yellow tinged with a faint haze and under slight pressure. Report on fluid showed - protein 110mg%, chloride 700mg%, 75 cells per cm3. One acid fast bacillus seen. Colloidal gold normal. Wassermann reaction negative. The child became extremely irritable and neck rigidity more marked. 16.2.38. Patient comatose with muscular twitchings. Neck rigidity marked but no Kernig's sign. Fundus normal. Lungs showed a few ronchi and rales.

PATHOLOGY

The tips of both tempero-sphenoidal lobes have been cut away to expose the fissures of Sylvius. The basal meninges are opalescent and show a rather gelatinous exudate. This is best seen in the inter-penduncular space and in the Sylvian fissures. Along the course of the vessels, especially the middle cerebrals, numerous small round opaque cream-coloured foci can be seen (Miliary tubercles). On the back of the specimen, the meningitis can be seen spreading over the upper surface of the cerebellum. The brain itself is congested and the ependyma is rather opaque though no tubercles can be seen in it.