The Role of Early Rehabilitation in Better Outcomes in a Rare Presentation of Tuberculous Meningitis With Broca's Aphasia

Abstract

There is a complex link between tuberculous meningitis (TBM) and aphasia, in which a language impairment is caused by an injury to the cortical language centre. The parts of the brain that function for speech and language production are the Wernicke's, Broca's, and arcuate fasciculus regions. This case report mainly highlights the neurological consequences of TBM, and how it affects language and speech functioning. It outlines a comprehensive physiotherapy rehabilitation program that targets a range of issues for the patient, such as verbal output, weakness, motor deficits, articulation issues in speech, and coordination issues. Various treatment modalities can help correct weakness, improve balance and coordination, increase flexibility and range of motion (ROM), and make speech more fluent. The case report emphasizes the necessity of using an integrated approach that combines speech-language therapy (SLT), melodic intonation therapy (MIT), constraint-induced aphasia therapy (CIAT), medication treatments, and physical therapy to address the multifaceted impacts of TBM-induced aphasia on a patient's quality of life (QOL).

Keywords: broca's aphasia; medical therapy; recurrent low-frequency transcranial magnetic stimulation; speech-language therapy; transcranial direct current stimulation; tubercular meningitis.

Figure 1. Brudzinski's sign was positive indicating neck rigidity; passive flexion of the neck caused slight flexion of both legs and thigh

Figure 2. MRI showing bilateral periventricular deep white matter showing small vessel ischemic changes (red arrow)

Figure 3. Patient performing active assisted lower limb exercises

Figure 4. Patient performing active assisted pelvic bridging

Figure 5. Therapist assisting in performing upper limb mobility exercises

Figure 6. The patient was asked to perform balloon activities to improve the inspiratory capacity