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A complicated case of altered sensorium

Kushaal Vikram1, K N Shivashankara, Joydeep Chakraborty

  • 1Department of Cardiology, GB Pant Hospital, New Delhi, India.

BMJ Case Reports
|August 20, 2013
PubMed

Insights

Central nervous system (CNS) tuberculosis and cerebral malaria can present similarly, complicating diagnosis. This case highlights how MRI can differentiate CNS tuberculosis, even when initial malaria treatment fails, leading to successful outcomes with antitubercular therapy.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Tuberculosis and malaria are prevalent in the Indian subcontinent, both causing severe neurological complications.
  • Differentiating between central nervous system (CNS) tuberculosis and cerebral malaria can be clinically challenging.
  • Focal neurological deficits are more characteristic of CNS tuberculosis than cerebral malaria.

Observation:

  • A 48-year-old woman presented with fever and altered sensorium, initially treated for falciparum malaria based on peripheral smear results and a normal CT scan.
  • Persistent symptoms and the development of focal neurological signs prompted further investigation.
  • Brain MRI revealed multiple tuberculomas, leading to a diagnosis of CNS tuberculosis.

Findings:

  • Magnetic Resonance Imaging (MRI) proved crucial in differentiating CNS tuberculosis from cerebral malaria.
  • Early and accurate diagnosis of CNS tuberculosis is essential for effective management.
  • Prompt initiation of antitubercular treatment (ATT) and corticosteroids led to significant clinical improvement.

Implications:

  • This case underscores the importance of considering CNS tuberculosis in patients with neurological symptoms, especially in endemic areas.
  • Advanced imaging like MRI is vital for accurate diagnosis when clinical presentation is ambiguous.
  • Timely diagnosis and treatment of CNS tuberculosis can prevent severe neurological sequelae and improve patient outcomes.

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