Central Nervous System Tuberculosis

Aka: Central Nervous System Tuberculosis, Tuberculous Meningitis, Intracranial Tuberculoma, Spinal Tuberculous Arachnoiditis

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II. Distribution

  1. Tuberculous Meningitis (most common)
    1. Results from extension of tuberculoma
  2. Intracranial Tuberculoma
  3. Spinal Tuberculous Arachnoiditis

III. Symptoms: Tuberculous Meningitis

  1. Initial phase lasts ~2 weeks
    1. Prodromal malaise, fever and Headache
    2. Personality changes may be seen
  2. Later
    1. Severe Headache
    2. Vomiting
    3. Confusion
  3. Final
    1. Coma

IV. Signs: Tuberculous Meningitis

  1. Cranial Nerve palsy
  2. Communicating Hydrocephalus
  3. Focal neurologic deficit
  4. Altered Level of Consciousness
  5. Meningeal signs

V. Labs: CSF

  1. CSF Lymphcytes: 100-500 cells/ul
  2. CSF Protein: 100-500 mg/dl or higher
  3. CSF Glucose: <45 mg/dl
  4. Xanthochromia
  5. CSF Adenosine deaminase increased
  6. CSF Diagnosis
    1. CSF AFB smear
      1. Test Sensitivity varies up to 90%
      2. Increase sensitivity with 2-3 large volume taps
    2. CSF Culture for Mycobacterium tuberculosis
      1. Test Sensitivity varies up to 90%
      2. Requires up to 6 weeks for results
    3. Do not use CSF PCR for diagnosis (low yield)

VI. Imaging

  1. CT Head

VII. Management

  1. See Extrapulmonary Tuberculosis
  2. Start empiric treatment if suspected
  3. Antituberculous drugs for 9-12 months
  4. Use concurrent Dexamethasone for first 6-8 weeks

VIII. References

  1. Donald (2004) N Engl J Med 351:1719-20 [PubMed]

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