[Clinical evaluation in the early diagnosis of tuberculous meningoencephalitis]

In this short review, the Author evaluates the most important diagnostic problems about tuberculous meningoencephalitis. Any inadequate therapy can alternate the clinical picture and the results of the cerebrospinal fluid examination, and the clinical evaluation may become very difficult. The neuroradiological findings (CT and MRI), even when correlated to the typical neuropathological features of the disease, could be very sensitive but not specific. An accurate evaluation of the clinical context and, above all, of the clinical history, is the best way to avoid a tardive diagnosis and inappropriate therapies, and to choose which diagnostic procedures must be performed. In the latest years, the immunodeficiency status related to HIV infection, and the mobility of many persons from geographic areas endemic for TBC stressed the importance of this diagnosis. The extreme variability of the clinical picture is discussed, and the author describes the common manifestations as well as the rare syndromes associated with this disorder. The review indicates also the diseases with which the neurologist must challenge for a differential diagnosis. Some practical suggestions indicate how to minimize a diagnostic and therapeutic delay, for a disorder that in many cases is still lethal or leading to serious neurological complications or sequelae.