• Saroj Yadav, Santosh Acharya, Astha Thapa, Aditya Hirday, and Agnimshwor Dahal.
• Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal.
• JNMA J Nepal Med Assoc. 2022 Jul 1; 60 (251): 654656654-656.

UnlabelledTubercular meningitis is a devastating presentation of extra pulmonary tuberculosis, with fatality in each case without treatment. A 39 years male, a regular consumer of alcohol and a known case of major depressive disorder, presented with the alleged history of using an electric heater in a closed room, and presented to emergency with unconsciousness and cardiac arrest. As his neurological status didn't improve over 72 hrs, a magnetic resonance imaging brain was done which was non-conclusive. Electroencephalogram revealed diffuse right fronto-parietal seizure activity ceasing with midazolam injection, hence levetiracetam was started. Lumbar puncture revealed increased adenosine deaminase and nil white blood cells. Repeat lumbar puncture showed lymphocytic-predominant pleocytosis, elevated protein and low glucose. The patient was started on anti-tubercular therapy and an injection of dexamethasone was added. Repeat electroencephalogram didn't show any seizure-like activity. It is important to be aware of variety of presentations of tubercular meningitis. Delay in treatment leads to irreversible neurological damage and even death.Keywordscardiac arrest; case report; tubercular meningitis; unconsciousness.

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