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This is the commonest manifestation of tuberculous infection of the nervous system. In children, it usually results from bacteraemia following the initial phase of primary pulmonary tuberculosis.

In adults, it may occur many years 1

after the primary infection.

Following bacteraemia, metastatic foci of infection lodge in:

1. Meninges

2. Cerebral or spinal tissue

3. Choroid plexus

Rupture of these encapsulated foci results in spread of infection into the subarachnoid space. In adults, reactivity of metastatic foci may occur spontaneously or result from impaired immunity (e.g. recent measles, alcohol abuse, administration of steroids).

The clinical features of tuberculous meningitis (TBM) result from:

- Infection.

- Exudation - which may obstruct the basal cisterns and result in hydrocephalus.

- Vasculitis - secondary to inflammation around vessels, resulting in infarction of brain and spinal cord. The basal meninges are generally most severely affected.

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