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Neuromyelitis optica (Devic's syndrome) and pulmonary tuberculosis
M H Silber1, P A Willcox, R M Bowen
1Department of Neurology, Groote Schuur Hospital, Cape Town, South Africa.
Neurology
|June 1, 1990
Summary
Neuromyelitis optica and related myelopathy can occur with pulmonary tuberculosis. This suggests an immune response to tuberculosis, not medication, causes these neurological conditions.
Area of Science:
- Neurology
- Immunology
- Infectious Diseases
Background:
- Neuromyelitis optica (NMO) and acute necrotic myelopathy are severe neurological conditions.
- Pulmonary tuberculosis is a common infectious disease globally.
Observation:
- Eight patients presented with neurological symptoms (NMO, myelopathy, optic neuropathy) temporally linked to pulmonary tuberculosis.
- Neurological symptoms often preceded tuberculosis treatment.
- Clinical features were consistent across patients.
Findings:
- Autopsy revealed extensive spinal cord and optic nerve demyelination in one patient.
- The incidence of these neurological conditions in association with tuberculosis was higher than expected for idiopathic cases.
- No evidence of central nervous system tuberculosis was found.
Implications:
- The findings suggest a strong association between pulmonary tuberculosis and these specific neurological syndromes.
- The underlying mechanism is likely an immune-mediated reaction to tuberculosis, rather than a direct infection or medication side effect.
- This highlights the importance of considering tuberculosis in the differential diagnosis of demyelinating neurological disorders.