Intracranial tuberculomas and caries spine: an experience from Children's Hospital Islamabad
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1The Children's Hospital, Pakistan Institute of Medical Sciences, Islamabad, Pakistan. muneeb@sat.net.pk
Insights
Central nervous system tuberculosis, including cerebral tuberculomas and spinal tuberculosis, is a significant concern in children. Prompt diagnosis and treatment are crucial for favorable outcomes in these serious infections.
Area of Science:
- Pediatrics
- Neurology
- Infectious Diseases
Background:
- Pulmonary tuberculosis is common in Pakistani children, but central nervous system (CNS) involvement data is limited.
- Tuberculosis of the nervous system presents a serious health risk with high morbidity and mortality if untreated.
- This study focuses on the occurrence of less common forms of CNS tuberculosis in pediatric patients.
Purpose of the Study:
- To investigate the incidence and characteristics of intracranial tuberculomas and spinal tuberculosis in children.
- To emphasize the importance of early detection and management of CNS tuberculosis in pediatric populations.
Main Methods:
- Retrospective analysis of pediatric patient records diagnosed with cerebral tuberculoma or spinal tuberculosis (1994-2002).
- Diagnostic criteria included clinical presentation, exposure history, chest X-rays, and neuroimaging (CT, MRI, myelography).
Main Results:
- Nine children presented with cerebral tuberculomas (some multiple/bilateral); eight had spinal tuberculosis (caries spine).
- Pulmonary tuberculosis was evident in 53% of patients; 41% had a family history of tuberculosis.
- Outcomes varied: 8 patients recovered with neurological deficits, and one child with cerebral tuberculomas died.
Conclusions:
- Intracranial tuberculomas and spinal tuberculosis are not uncommon in children.
- Early diagnosis and timely antitubercular therapy are vital for improving patient outcomes.
- Neurological deficits are a common sequela, highlighting the need for aggressive management.
Background:
Pulmonary tuberculosis in infants and children in Pakistan is quite common. However, there is limited data about uncommon forms of tuberculous infection of central nervous system. Tuberculosis of nervous system is a serious disease and if not treated adequately, carries high morbidity and mortality. This study was undertaken to highlight the occurrence of relatively uncommon forms of tuberculosis in children.
Methods:
This was a retrospective review of the case records of the patients who were admitted in Children's Hospital, Islamabad with the diagnosis of cerebral tubercloma or tuberculosis of spine between January, 1994 and August, 2002. Diagnosis was based on clinical features, history of contact with tuberculous patient, abnormalities on chest X-rays and neuroimaging studies of brain and spine.
Results:
Nine children had cerebral tuberculomas, six more than one and in five were bilateral. Eight had caries spine, 2 cervical, 4 thoracic and 2 lumbar regions. Three had been vaccinated with Bacillus-Calemette-Guerin and family history of tuberculosis was positive in 7 (41%) children. Nine (53 %) patients had evidence of pulmonary tuberculosis on chest x-ray. Ten computed scan brain, four magnetic resonance imaging, two spinal scan and two myelographic studies were performed. Three patients with tuberculomas and five with caries recovered and 8 were left with neurological deficit. One child with cerebral tuberculomas died.
Conclusion:
Intracranial tuberculomas and spinal tuberculosis are not rare problems in children. Early diagnosis and prompt antituberculous therapy are the most important factors for the favourable outcome.
