The CSF of patients with treated TB meningitis is commonly abnormal even at 12 months; the rate of resolution of the abnormality bears no correlation with clinical progress or outcome, and is not an indication for extending or repeating treatment; repeated sampling of CSF by lumbar puncture to monitor treatment progress should therefore not be done.Although TB meningitis and TB cerebritis are classified together, the experience of many clinicians is that their progression and response to treatment is not the same. TB meningitis usually responds well to treatment, but TB cerebritis may require prolonged treatment (up to two years) and the steroid course needed is often also prolonged (up to six months). Unlike TB meningitis, TB cerebritis often required repeated CT or MRI imaging of the brain to monitor progress.Central nervous system TB may be secondary to blood-borne spread: therefore some experts advocate the routine sampling of CSF in patients with miliary TB.The anti-TB drugs that are most useful for the treatment of Central nervous system TB are:
INH (CSF penetration 100%)
RMP (10–20%)
EMB (25–50% inflamed meninges only)
PZA (100%)
STM (20% inflamed meninges only)
LZD (20%)
Cycloserine (80–100%)
Ethionamide (100%)
PAS (10–50%) (inflamed meninges only)The use of steroids is routine in TB meningitis (see section below). There is evidence from one poorly designed trial that aspirin may be beneficial, but further work is required before this can be recommended routinely. Steroids
The usefulness of corticosteroids (e.g., prednisolone or dexamethasone) in the treatment of TB is proven for TB meningitis and TB pericarditis.
Tricuspid valve stenosis is a valvular heart disease that narrows the opening of the hearts tricuspid valve. It is a relatively rare condition that causes stenosis (increased restriction of blood flow through the valve). Cause
Causes of tricuspid valve stenosis are:
Rheumatic disease
Carcinoid syndrome
Pacemaker leads (complication)

Diagnosis
A mild diastolic murmur can be heard during auscultation caused by the blood flow through the stenotic valve. It is best heard over the left sternal border with rumbling character and tricuspid opening snap with wide-splitting S2. The diagnosis will typically be confirmed by an echocardiograph, which will also allow the physician to assess its severity. Treatment
Tricuspid valve stenosis itself usually does not require treatment. If stenosis is mild, monitoring the condition closely suffices. However, severe stenosis, or damage to other valves in the heart, may require surgical repair or replacement. The treatment is usually by surgery (tricuspid valve replacement) or percutaneous balloon valvuloplasty. The resultant tricuspid regurgitation from percutaneous treatment is better tolerated than the insufficiency occurring during mitral valvuloplasty. See also
Echocardiography
Tricuspid valve

References


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