Neuro

Central Nervous System Tuberculosis

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Central Nervous System Tuberculosis, Tuberculous Meningitis, Intracranial Tuberculoma, Spinal Tuberculous Arachnoiditis

  • Distribution
  1. Tuberculous Meningitis (most common)
    1. Results from extension of tuberculoma
  2. Intracranial Tuberculoma
  3. Spinal Tuberculous Arachnoiditis
  • Symptoms
  • Tuberculous Meningitis
  1. Initial phase lasts ~2 weeks
    1. Prodromal malaise, fever and Headache
    2. Personality changes may be seen
  2. Later
    1. Severe Headache
    2. Vomiting
    3. Confusion
  3. Final
    1. Coma
  • Signs
  • Tuberculous Meningitis
  1. Cranial Nerve palsy
  2. Communicating Hydrocephalus
  3. Focal neurologic deficit
  4. Altered Level of Consciousness
  5. Meningeal signs
  • Labs
  • CSF
  1. CSF Lymphcytes: 100-500 cells/ul
  2. CSF Protein: 100-500 mg/dl or higher
  3. CSF Glucose: <45 mg/dl
  4. Xanthochromia
  5. CSF Adenosine deaminase increased
  6. CSF Diagnosis
    1. CSF AFB smear
      1. Test Sensitivity varies up to 90%
      2. Increase sensitivity with 2-3 large volume taps
    2. CSF Culture for Mycobacterium tuberculosis
      1. Test Sensitivity varies up to 90%
      2. Requires up to 6 weeks for results
    3. Do not use CSF PCR for diagnosis (low yield)
  • Imaging
  1. CT Head
  • Management
  1. See Extrapulmonary Tuberculosis
  2. Start empiric treatment if suspected
  3. Antituberculous drugs for 9-12 months
  4. Use concurrent Dexamethasone for first 6-8 weeks
  • References
  1. Donald (2004) N Engl J Med 351:1719-20 [PubMed]