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Reversible multifocal encephalopathy following tuberculous infection
L Provinciali1, M Del Pesce, B Censori
1Istituto delle Malattie del Sistema Nervoso, Università di Ancona.
Abstract:
Tuberculous encephalic infection is commonly reported as confined to Asians or Africans or people living in poor hygienic conditions; very often it follows meningitis in patients with lung TB infection. We describe three western patients coming from good social environment and suffering from multifocal tuberculous encephalopathy. Two of them showed neither meningitis or lung TB when CNS involvement appeared. Complete recovery after therapy is described, together with the evolution of brain CT and, in 1 case, MRI features. The instrumental findings accompanying the complete recovery suggest that the lesions described in these cases are a localized form of encephalitis responsive to medical treatment, unlike tuberculomas, which often need surgical treatment. The occurrence of tuberculous encephalic infection in western, middle-class patients with or without meningitis emphasizes that tuberculous encephalopathy must be considered in the differential diagnosis of multifocal brain lesions.
Insights
Tuberculous encephalopathy, a brain infection, can occur in Western patients without lung TB or meningitis. This multifocal condition shows complete recovery with treatment, unlike tuberculomas.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Tuberculous encephalopathy is typically associated with Asian or African populations and poor hygiene.
- It often presents secondary to meningitis in patients with pulmonary tuberculosis.
Observation:
- This study details three Western patients from affluent backgrounds with multifocal tuberculous encephalopathy.
- Two patients lacked preceding meningitis or pulmonary tuberculosis at the onset of central nervous system involvement.
Findings:
- Complete recovery was observed following medical therapy in all patients.
- Brain CT and MRI scans showed lesion evolution consistent with encephalitis, distinct from surgically treated tuberculomas.
Implications:
- Tuberculous encephalopathy should be considered in the differential diagnosis of multifocal brain lesions, even in Western, middle-class individuals.
- The findings suggest tuberculous encephalopathy is a treatable, localized form of encephalitis.