Tuberculosis of the central nervous system

Area of Science:

• Neurology
• Infectious Diseases
• Public Health

Background:

• Tuberculosis (TB) can affect any organ system, with nervous system (NS) involvement being less common but significant.
• Untreated Central Nervous System (CNS) tuberculosis leads to severe morbidity and mortality.
• Tubercle bacilli cause chronic, caseating granulomatous lesions within the NS.

Purpose of the Study:

• To highlight the importance of early diagnosis and prompt treatment for NS tuberculosis.
• To outline the clinical presentations and diagnostic methods for CNS tuberculosis.
• To emphasize the necessity of prolonged combination therapy for effective management.

Main Methods:

• Cerebrospinal fluid (CSF) analysis, including cell count, Gram staining, culture, and Polymerase Chain Reaction (PCR).
• Neuroimaging techniques (e.g., CT scans) to detect tuberculomas and abscesses.
• Computed tomography (CT)-guided Fine Needle Aspiration for Cytology (FNAC) for histopathological confirmation.

Main Results:

• Tubercular meningitis symptoms include fever, headache, neck stiffness, and cranial nerve palsy.
• Tuberculomas can manifest as headache, seizures, and focal neurological deficits.
• Spinal cord involvement may lead to paraparesis or quadriparesis due to tuberculomas or abscesses.

Conclusions:

• Early diagnosis of NS tuberculosis through CSF analysis and neuroimaging is essential.
• Prompt treatment with a combination of antitubercular drugs for 12-18 months is critical.
• Effective management strategies are vital to reduce mortality and long-term disability from CNS tuberculosis.