When in the rapid course of the development of miliary tuberculosis the lodgment of the tubercules is. made in the pia mater of the brain, the symptoms are those of a basilar meningitis. This occurs quite frequently. It occurs in children principally under eight years of age, but may develop in early adult life.
Symptomatology:—The premonitory symptoms of headache, general distress and indisposition are apparent for a number of days, the appetite is lost, the tongue is coated, there is nausea, and usually regurgitation of food, rather than actual vomiting. There is gastro-intestinal irritation, with marked constipation, the patient grinding its teeth when asleep and talking, or starting up, in the sleep. The child becomes emaciated and worn-looking, and there is some impairment of the mental faculties. Ultimately a chill occurs, which is followed by fever, the child shows marked signs of irritability and occasionally screams out with sharp penetrating shrieks, and, if old enough, clasps its head with its hands. In some cases there are convulsions early in the disease, with paralysis and perhaps coma. The pupils are contracted at first, and the headache increases to pain, which is aggravated by excitement and noise, and is relieved if the patient be kept quiet and in a darkened room. The fever usually does not rise as high as in the other forms of tuberculosis. The pulse is small and frequent, but not generally above 125 beats per minute. The respiration is only slightly increased at first, the secretions are deficient, the mouth and tongue are dry, the skin dry and rough and the pupils irregular.
In the final stage of the disease the child becomes more quiet, there is less headache, the stupor increases and general convulsions may occur. The facial muscles twitch violently and ultimately there is facial paralysis, or there may be paraplegia. Local paralyses are quite common. As a state of paralysis develops the temperature abates and finally may become sub-normal until a short time before death, when it may rise to 107° or 108° F.
Prognosis:—These cases usually terminate fatally. They may run their entire course in two weeks, but usually about six weeks is the limit; occasionally they will assume the so-called chronic form and may last a number of months.
Treatment:—The fact that a fatal termination is anticipated, must not cause the treatment of the patient to be neglected. Specific indications must be promptly met, but the treatment must necessarily be general in character. A course similar, in its constitutional influence to that advised for pulmonary tuberculosis, should be adopted.