Cerebellar Tremor Caused by Meningoencephalitis Tuberculosis in A 17-Year-Old Patient: A Case Report
DOI:
https://doi.org/10.18196/mmjkk.v25i1.23232Keywords:
cerebellar tremor, meningoencephalitis, tuberculosis, childAbstract
Meningitis Tuberculosis (TB) is a rare manifestation of extrapulmonary TB and can progress to Meningoencephalitis. Cerebellar tremor is a tremor in the head caused by cerebellar diseases such as strokes, tumors, multiple sclerosis, and certain drugs. This study describes a case of a 17-year-old boy who was infected with TB meningoencephalitis with cerebellar tremors. A 17-year-old boy came to the emergency room at K.R.M.T. Wongsonegoro Hospital with the main complaint of shaking head. The patient was diagnosed with meningoencephalitis TB and cerebellar tremors. Meningitis TB occurs due to the hematogenous spread of primary pulmonary TB or from rupture of the subependymal tubercles into the subarachnoid space and can progress to Meningoencephalitis. Clinical manifestations that can appear are a combination of meningitis and encephalitis and movement disorders caused by encephalitis. The management obtained in this patient was TB drugs, corticosteroids, and anti-seizures. Cerebellar tremor is one of the clinical manifestations caused by Tuberculosis encephalitis that must be watched out for to get adequate treatment.
References
Penman ID, Ralston SH, Strachan MWJ, Hobson R. Davidson’s Principles and Practice of Medicine. 24th ed. Penman ID, Ralston SH, Strachan MWJ, Hobson R, editors. United Kingdom: Elsevier Health Sciences; 2022. https://shop.elsevier.com/books/davidsons-principles-and-practice-of-medicine/penman/978-0-7020-8347-1#full-description
Seddon JA, Tugume L, Solomons R, Prasad K, Bahr NC, Aarnoutse RE, et al. The current global situation for tuberculous meningitis: epidemiology, diagnostics, treatment and outcomes. Wellcome Open Res. 2019;4. https://pmc.ncbi.nlm.nih.gov/articles/PMC7029758/
Natarajan A, Beena PM, Devnikar A V., Mali S. A systemic review on tuberculosis. Indian J Tuberc. 2020 Jul;67(3):295–311. https://pubmed.ncbi.nlm.nih.gov/32825856/
He R li, Liu Y, Tan Q, Wang L. The rare manifestations in tuberculous meningoencephalitis: a review of available literature. Ann Med. 2023;55(1):342. https://pubmed.ncbi.nlm.nih.gov/36598144/
Drislane FW, Benatar M, Chang B, Acosta J, Tarulli A, Caplan L. Blueprints: Neurology. 3rd ed. Philadelphia: Wolters Kluwer; 2009. https://book.bsmi.uz/web/kitoblar/152369640.pdf
Schaller MA, Wicke F, Foerch C, Weidauer S. Central Nervous System Tuberculosis : Etiology, Clinical Manifestations and Neuroradiological Features. Clin Neuroradiol. 2019 Mar;29(1):3–18. https://pubmed.ncbi.nlm.nih.gov/30225516/
Magliozzi R, Howell OW, Calabrese M, Reynolds R. Meningeal inflammation as a driver of cortical grey matter pathology and clinical progression in multiple sclerosis. Nat Rev Neurol [Internet]. 2023 Aug 3;19(8):461–76. Available from: https://www.nature.com/articles/s41582-023-00838-7
Gupta M, Munakomi S. CNS Tuberculosis. Infect Cent Nerv Syst Pathol Genet. 2023 Feb;349–56. https://pubmed.ncbi.nlm.nih.gov/36256788/
Navarro-Flores A, Fernandez-Chinguel JE, Pacheco-Barrios N, Soriano-Moreno DR, Pacheco-Barrios K. Global morbidity and mortality of central nervous system tuberculosis: a systematic review and meta-analysis. J Neurol. 2022 Jul;269(7):3482. https://pubmed.ncbi.nlm.nih.gov/35288778/
Kakei S, Manto M, Tanaka H, Mitoma H. Pathophysiology of Cerebellar Tremor: The Forward Model-Related Tremor and the Inferior Olive Oscillation-Related Tremor. Front Neurol. 2021 Jun;12:694653. https://pmc.ncbi.nlm.nih.gov/articles/PMC8273235/
Louis ED. Essential tremor. Handb Clin Neurol. 2011;100:433–48. https://pubmed.ncbi.nlm.nih.gov/21496600/
Involuntary Movements: Types, Causes, and Examples, Stanford 25 | Stanford Medicine 25 | Stanford Medicine. https://stanfordmedicine25.stanford.edu/the25.html
Rahman FF, Nur S, Cokro A, Oktaviani LW. The Impact of Healthcare Worker Safety Culture on Outpatient Patient Satisfaction in Public Hospitals. Mutiara Med J Kedokt dan Kesehat. 2024;24(1):1–8. http://dx.doi.org/10.18196/mmjkk.v24i1.19571
Hersi K, Gonzalez FJ, Kondamudi NP. Meningitis. StatPearls. 2022 Aug; https://www.ncbi.nlm.nih.gov/books/NBK459360/
Simon RP, Aminoff MJ, Greenberg DA. Clinical Neurology. 10th ed. Vol. 18, McGraw-Hill Education. United States: McGraw-Hill Education; 2018. https://accessmedicine.mhmedical.com/content.aspx?bookid=2274§ionid=176231202
World Health Organization. Meningitis [Internet]. 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/meningitis
Kementerian Kesehatan Republik Indonesia. Panduan Deteksi dan Respon Penyakit Meningitis Meningokokus. Jakarta: Kementerian Kesehatan Republik Indonesia; 2019. https://infeksiemerging.kemkes.go.id/document/panduan-deteksi-dan-respon-meningitis-meningokokus/view
Ropper AH, Samuels MA, Klein JP, Prasad S. Adams and Victor’s Principles of Neurology. 11th ed. United States: McGraw-Hill Education; 2019. https://neurology.mhmedical.com/content.aspx?bookid=1477§ionid=85536145
Ungureanu A, van der Meer J, Bicvic A, Abbuehl L, Chiffi G, Jaques L, et al. Meningitis, meningoencephalitis and encephalitis in Bern: an observational study of 258 patients. BMC Neurol. 2021 Dec;21(1). https://pubmed.ncbi.nlm.nih.gov/34872509/
Hauser SL, Josephson SA. Harrison’s Neurology in Clinical Medicine. 4th ed. United States: Mc Graw Hill Education; 2017. https://neurology.mhmedical.com/content.aspx?bookid=2207§ionid=169222561
Manyelo CM, Solomons RS, Walzl G, Chegou NN. Tuberculous Meningitis: Pathogenesis, Immune Responses, Diagnostic Challenges, and the Potential of Biomarker-Based Approaches. J Clin Microbiol. 2021 Mar;59(3):267–80. https://pubmed.ncbi.nlm.nih.gov/33087432/
Davis AG, Rohlwink UK, Proust A, Figaji AA, Wilkinson RJ. The Pathogenesis of Tuberculous Meningitis. J Leukoc Biol. 2019 Feb;105(2):267. https://pubmed.ncbi.nlm.nih.gov/30645042/
Brust JCM. Current Diagnosis & Treatment in Neurology. Vol. 61, Neurosurgery. United States: Mc Graw Hill Education; 2019. https://accessmedicine.mhmedical.com/book.aspx?bookid=2567
Méneret A, Garcin B, Frismand S, Lannuzel A, Mariani LL, Roze E. Treatable Hyperkinetic Movement Disorders Not to Be Missed. Front Neurol. 2021 Dec;12:659805. https://pubmed.ncbi.nlm.nih.gov/34925200/
Angelini L, Paparella G, De Biase A, Maraone A, Panfili M, Berardelli I, et al. Longitudinal study of clinical and neurophysiological features in essential tremor. Eur J Neurol [Internet]. 2023 Mar 11;30(3):631–40. Available from: https://onlinelibrary.wiley.com/doi/10.1111/ene.15650
Arshad A, Dayal S, Gadhe R, Mawley A, Shin K, Tellez D, et al. Analysis of Tuberculosis Meningitis Pathogenesis, Diagnosis, and Treatment. J Clin Med. 2020 Sep;9(9):1–19. https://pmc.ncbi.nlm.nih.gov/articles/PMC7565176/
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