Clinical features

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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

- Lethargy

Stage 2 (intermediate) Confusion

Cranial nerve paresis

Stage 3 (advanced) Coma

Meningism Vasculitis

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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