Tuberculosis of the central nervous system

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Background:

• Central nervous system (CNS) tuberculosis is a severe infection requiring prompt diagnosis and management.
• Clinical presentation varies, encompassing meningitis and intracranial tuberculomas.
• Diagnostic confirmation can be challenging, particularly in cases without systemic evidence of tuberculosis.

Observation:

• Of 27 patients, 17 had CNS tuberculous meningitis, with bacteriological confirmation in nine.
• Acid-fast bacilli (AFB) in cerebrospinal fluid (CSF) indicated a poor prognosis.
• Intracranial tuberculomas were observed in 11 patients, with CT scans often showing non-specific mass lesions.
• Biopsy carried significant risk, causing mortality in two patients.

Findings:

• Rifampicin treatment was associated with a high incidence of hepatitis.
• Satisfactory outcomes were achieved in most patients without AFB cultured from CSF.
• CT scan was crucial for assessing treatment response in tuberculoma cases.

Implications:

• Non-invasive diagnosis and medical management, guided by CT imaging, are preferred for CNS tuberculosis.
• Minimizing surgical intervention is critical due to associated risks.
• Further research into managing rifampicin-induced hepatitis in this context is warranted.