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[Tuberculous cranial pachymeningitis presenting with long-standing diffuse brain dysfunction].
Toshihisa Sugita1, Hirotaka Katoh, Daigo Hayashi
1Department of Neurology, Showa University School of Medicine.
Rinsho Shinkeigaku = Clinical Neurology
|May 21, 2011
Summary
Tuberculous cranial pachymeningitis can cause chronic brain dysfunction without typical symptoms like fever. Early diagnosis using specific tests and prompt treatment with anti-tuberculous agents and corticosteroids led to symptom regression.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Tuberculous cranial pachymeningitis is a rare form of central nervous system tuberculosis.
- It can present insidiously with non-specific neurological deficits.
Observation:
- A 59-year-old immunocompetent male presented with progressive gait unsteadiness, dysarthria, and attention deficits over six months.
- Clinical examination revealed bilateral pyramidal signs and pseudobulbar palsy.
- Cerebrospinal fluid analysis showed mild pleocytosis, and MRI demonstrated a pachymeningeal enhancement pattern.
Findings:
- Interferon-gamma release assay was positive for tuberculosis antigens.
- Polymerase chain reaction detected Mycobacterium tuberculosis in cerebrospinal fluid.
- The patient's pachymeningitis regressed following combination therapy with anti-tuberculous agents and corticosteroids.
Implications:
- Tuberculous cranial pachymeningitis should be considered in the differential diagnosis of chronic diffuse brain dysfunction, even without classic symptoms like headache or fever.
- This case highlights the utility of specific diagnostic assays and the effectiveness of combined anti-tuberculous and corticosteroid therapy.
- Early recognition and treatment are crucial for favorable outcomes in this rare neurological complication of tuberculosis.
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