Introduction:
Nonconvulsive status epilepticus (NCSE) is a serious epileptic condition
in which there is minimal or no motor activity. Electrical activity in
NCSE is continuous, lasting at least 30 minutes and leads to changes in
mental or behavioral status (1, 2). NCSE is relatively common and
constitutes 20–25% of all status epilepticus cases (3). It is often
difficult to diagnose NCSE, as there is minimal or no objective
convulsive activity and many other conditions can change the mental
status in predisposing conditions of NCSE. The underdiagnosis may lead
to detrimental results (4).
Treatment can be delayed as mental status changes without obvious
convulsions. Treatment is not simple and depends on many factors,
including the etiology, electroencephalogram (EEG) findings, and the
patient’s clinical condition(3). Etiologies include idiopathic epilepsy
syndrome, metabolic disorders, trauma, brain tumors, cerebral hypoxia,
and infectious diseases (5).
Tuberculous meningoencephalitis (TBM) compromise 1% of all TB cases
(6). It is a life-threatening form of central nervous system infection,
with significantly higher mortality and neurological impairment among
infected people. TBM has a
subacute onset of symptoms with non-specific clinical signs that may
persist for weeks, often making early diagnosis difficult. It is
characterized by fever, headache, vomiting, focal neurological signs or
coma (7).
Seizures have been reported in 17% to 93% of patients with TBM (8).
The seizures in TBM can be either focal or generalized tonic-clonic
seizure and convulsive or non-convulsive status epilepticus (9). The
etiology of TBM seizures is multifactorial and has been identified
independently or in combination due to meningeal irritation, cerebral
edema, tuberculoma, infarction, hydrocephalous and hyponatremia.
Seizures in TBM can occur during the active phase or as sequel of
meningitis. It can even be the characteristic of CNS tuberculosis
(heraldic seizure) in 10% of all patients (10).
Here we report a rare presentation of TBM where the patient presented
with NCSE and tuberculous meningitis. This case highlights the
importance of clinicians’ awareness on unusual clinical presentations of
TBM, because NCSE is hard to diagnose without having it constantly in
mind and delayed diagnosis is associated with a poor prognosis.