AN AYURVEDIC OUTLOOK ON STROKE SYNDROME AS NEUROLOGIC SEQUELAE OF TUBERCULOUS MENINGITIS (TBM)

Tuberculous meningitis (TBM), a potential extra-pulmonary manifestation of tuberculosis (TB) affecting the central nervous system (CNS) is an infectious bacterial disease caused by Mycobacterium tuberculosis. TB follows air borne transmission and mostly affects the lungs but can also involve the gastrointestinal, genitourinary and skeletal systems, brain, lymph nodes and pleura. Among CNS TB, TBM is the most threatening with increased mortality and associated neurological sequelae. It can occur with or without a pulmonary onset with occasional evidences of old pulmonary lesions. The symptoms include low-grade fever, malaise, anorexia and irritability for over weeks followed by headache and slight mental derangement. Unrecognized, symptoms may progress to severe headache, confusion, lethargy, altered sensorium and neck rigidity. The disease can evolve to coma, with hydrocephalus and intracranial hypertension. Culture of cerebrospinal uid (CSF) remains the gold standard in diagnosis with the Gene-Xpert as the widely accepted initial diagnostic tool. Imaging techniques (MRI and CT) are also widely done to detect tuberculoma, infarcts or hydrocephalus. Anti-tubercular treatment (ATT) is the baseline therapy initiated on diagnosis of TB. Among the complications, stroke syndrome that usually manifests as hemiparesis is highly common. The tubercular zone of the basal ganglia comprising of the caudate nucleus, anterior thalamus, anterior limb and genu of the internal capsule is the predominant site involved. According to Ayurveda, the clinical features of acute TBM can be simulated with lakshana of sannipata jwara, majjagata jwara and kantakubja. The major inammatory processes involved in the aetiopathogenesis of TBM can be considered as dhatupaka eventuating in balahani that manifest as pakshaghata in TBM survivors. Treatment which is predominantly vata-pittahara, balya and rasayana can be effective in reversing the condition.