Pathogenesis, diagnosis, treatment, and outcome aspects of cerebral tuberculosis

Cerebral tuberculosis or tuberculosis of the brain manifests predominantly as tuberculous meningitis followed by tuberculoma, tuberculous abscess, and other concomitant forms such as cerebral miliary tuberculosis, tuberculous encephalopathy, tuberculous encephalitis, and tuberculous arteritis. Different forms of cerebral tuberculosis are mainly caused by Mycobacterium tuberculosis and also by non-tuberculous mycobacteria such as M. avium-intracellulare in human immunodeficiency virus-infected persons. Cerebral tuberculosis is diagnosed based on clinical features, cerebrospinal fluid studies combined with radiological images. Early diagnosis, prompt institution of anti-tubercular treatment, and the clinical stage at which the patient presents are important and deciding factors for final outcome. The present review highlights the pathogenesis, recent strides made in diagnosis, including sensitive and specific molecular diagnostic (immunologic and polymerase chain reaction) tests, treatment, and outcome aspects of cerebral tuberculosis.