The majority of patients are adults; childhood TBM is now rare. Non-specific prodromal symptoms develop over 2-8 weeks.
Stage 1 (early) Non-specific symptoms
Stage 2 (intermediate) Confusion
Cranial nerve paresis
Stage 3 (advanced) Coma
Hemiparesis Quadraparesis Ataxia Dysarthria
Staging is useful for predicting outcome.
Seizures may occur at the onset. Involuntary movements (chorea, myoclonus) occur in 10%.
Atypically the illness may develop slowly over months presenting with dementia or rapidly like pyogenic (bacterial) meningitis. Occasionally cerebral features prevail rather than signs of meningitis.
Untreated, the illness may progress from phase 1 to death over a 3-week period. Arachnoiditis inflammatory exudate may result in hydrocephalus/dementia/blindness.
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