Tubercular meningitis has been classically described as sub-acute or chronic meningitis that evolves over a course of weeks to months. However in some cases the onset is acute or sometimes abrupt with features of encephalitis. In a review of adult patients of tubercular meningitis, 10 cases were found to have an acute presentation with features of encephalitis. Acute presentation was defined as symptom duration of 07 days or less. The international encephalitis consortium criteria were used for case definition of encephalitis. The patients varied in age between 14 to 35 years. Three patients had definite tubercular etiology while three were probable and four were possible tubercular encephalitis. Encephalopathy manifested in the form of worsening of sensorium in 06 patients, irritability in 02 and behavioral disturbance in 02 patients. The average duration of symptoms before presentation was 5.2 days. Signs of meningeal irritation were present in 09 patients. On CSF analysis, all patients showed pleocytosis with elevated CSF protein, while glucose was low in 08 patients. The average time delay before commencement of anti-tubercular treatment was 11.6 days. Nine patients improved while one died during hospital stay. Acute encephalitic presentation of central nervous system tuberculosis is an under recognized entity that requires a high index of suspicion. Early recognition of this entity can be life- saving and prevent serious complications.

Tubercular meningitis has been classically described as sub-acute or chronic meningitis that evolves over a course of weeks to months. However in some cases the onset is acute or sometimes abrupt with features of encephalitis. In a review of adult patients of tubercular meningitis, 10 cases were found to have an acute presentation with features of encephalitis. Acute presentation was defined as symptom duration of 07 days or less. The international encephalitis consortium criteria were used for case definition of encephalitis. The patients varied in age between 14 to 35 years. Three patients had definite tubercular etiology while three were probable and four were possible tubercular encephalitis. Encephalopathy manifested in the form of worsening of sensorium in 06 patients, irritability in 02 and behavioral disturbance in 02 patients. The average duration of symptoms before presentation was 5.2 days. Signs of meningeal irritation were present in 09 patients. On CSF analysis, all patients showed pleocytosis with elevated CSF protein, while glucose was low in 08 patients. The average time delay before commencement of anti-tubercular treatment was 11.6 days. Nine patients improved while one died during hospital stay. Acute encephalitic presentation of central nervous system tuberculosis is an under recognized entity that requires a high index of suspicion. Early recognition of this entity can be life- saving and prevent serious complications.