Tuberculous meningitis (TBM) in young children typically follows milliary dissemination of bacilli to the choroid plexus and then to the cerebrospinal fluid. The inflammatory reaction is concentrated in the basal cisterns.
In older age groups TBM typically follows rupture of a leptomeningeal / cortical tuberculoma ("Rich-McCord focus") into the cerebrospinal fluid.
A common complication of TBM is vasculitis and thrombosis of small penetrating vessels, leading to brain infarction and focal neurological deficits.
Other important complications are obstructive hydrocephalus and cranial nerve palsies. Deafness (8th cranial nerve) is especially common in survivors.
Infection with Human immunodeficiency virus (HIV) increases the risk of developing TBM, as well as the risk of complications and death.
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