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

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

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Related Studies

Ontology: Tuberculosis, Meningeal (C0041318)

Definition (NCI) A bacterial infection of the membranes covering the brain and the spinal cord caused by Mycobacterium tuberculosis.
Definition (MSH) A form of bacterial meningitis caused by MYCOBACTERIUM TUBERCULOSIS or rarely MYCOBACTERIUM BOVIS. The organism seeds the meninges and forms microtuberculomas which subsequently rupture. The clinical course tends to be subacute, with progressions occurring over a period of several days or longer. Headache and meningeal irritation may be followed by SEIZURES, cranial neuropathies, focal neurologic deficits, somnolence, and eventually COMA. The illness may occur in immunocompetent individuals or as an OPPORTUNISTIC INFECTION in the ACQUIRED IMMUNODEFICIENCY SYNDROME and other immunodeficiency syndromes. (From Adams et al., Principles of Neurology, 6th ed, pp717-9)
Concepts Disease or Syndrome (T047)
MSH D014390
ICD9 013.00, 013.0
ICD10 A17.0
SnomedCT 186214004, 186215003, 58437007
English Meningitis, Tuberculous, Tuberculous Meningitis, Tuberculous meningitis NOS, Tuberculous meningitis, unspecified examination, TUBERCULOUS MENINGITIS, tubercular meningitis, tubercular meningitis (diagnosis), Meningeal tuberculosis, TB meningitis, Meningitis tuberculous, Meningitides, Tuberculosis, Meningitis, Tuberculosis, Tuberculosis Meningitides, Tuberculosis Meningitis, TB meningitis-unspec, Tubercular Meningitides, Meningitides, Tuberculous, Tuberculoses, Meningeal, Meningitis, Tubercular, Meningeal Tuberculoses, Tubercular Meningitis, Meningitides, Tubercular, Tuberculous Meningitides, Meningeal Tuberculosis, Tuberculosis, Meningeal [Disease/Finding], Tuberculous meningitis, unspecified, Tuberculosis, Meningeal, meningitis tb, tb meningitis, tuberculosis meningitis, meningitis tuberculosis, meningitis tuberculous, Tuberculosis;meninges, meningeal tuberculosis, tuberculosis meningeal, tuberculosis meninges, tuberculous meningitis, TB Meningitis, TB Meningitides, Tuberculous meningitis (disorder), Tuberculous meningitis NOS (disorder), Meninges--Tuberculosis, Tuberculous meningitis, Tuberculosis of meninges, TB - Tuberculous meningitis, TBM - Tuberculous meningitis, Tuberculosis of meninges (disorder), meningeal TB
Italian Meningite tubercolare, Tubercolosi delle meningi, Meningite tubercolare, esame non specificato, Tubercolosi meningea
Dutch tuberculeuze meningitis, niet-gespecificeerd onderzoek, tuberculose van de hersenvliezen, TBC-meningitis, tuberculeuze meningitis, meningitis tuberculeus, Meningeale tuberculose, Meningitis, tuberculeuze, Tuberculeuze meningitis, Tuberculose, meningeale
French Méningite tuberculeuse, examen non précisé, Méningite tuberculeuse, Tuberculose méningée
German tuberkuloese Meningitis, unspezifische Untersuchung, meningeale Tuberkulose, tuberkuloese Meningitis, TB Meningitis, Tuberkuloese Meningitis, Meningitis tuberkuloes, Meningitis tuberculosa, Tuberkulose, meningeale, Hirnhautentzündung, tuberkulöse
Portuguese Meningite tuberculosa, exame NE, Tuberculose meníngea, Meningite tuberculosa, Meningite Tuberculosa, Tuberculose Meníngea
Spanish Meningitis TB, Tuberculosis meníngea, Meningitis tuberculosa, estudio no especificado, meningitis tuberculosa, SAI, meningitis tuberculosa, SAI (trastorno), meningitis tuberculosa (trastorno), meningitis tuberculosa, tuberculosis de la meninges (trastorno), tuberculosis de la meninges, Meningitis tuberculosa, Meningitis Tuberculosa, Tuberculosis Meníngea
Japanese 結核性髄膜炎、検査の詳細不明, 髄膜結核症, ケッカクセイズイマクエン, ケッカクセイズイマクエンケンサノショウサイフメイ, ズイマクケッカクショウ, 結核-髄膜, 結核性髄膜炎, 髄膜結核, 髄膜炎-結核性
Swedish Hjärnhinnetuberkulos
Czech tuberkulóza meningeální, Tuberkulózní meningitida, TBC meningitida, Tuberkulóza mozkových a míšních plen, Tuberkulózní meningitida, blíže neurčené vyšetření
Finnish Meningeaalinen tuberkuloosi
Korean 결핵성 수막염
Polish Gruźlica opon mózgowych, Zapalenie opon gruźlicze
Hungarian TBC meningitis, tuberculoticus meningitis, Meningealis tuberculosis, meningitis tuberculosa, tuberculoticus meningitis, nem meghatározott vizsgálat
Norwegian Hjernehinnetuberkulose, Tuberkuløs meningitt, Meningeal tuberkulose

Ontology: Intracranial Tuberculoma (C0085388)

Definition (MSH) A well-circumscribed mass composed of tuberculous granulation tissue that may occur in the cerebral hemispheres, cerebellum, brain stem, or perimeningeal spaces. Multiple lesions are quite common. Management of intracranial manifestations vary with lesion site. Intracranial tuberculomas may be associated with SEIZURES, focal neurologic deficits, and INTRACRANIAL HYPERTENSION. Spinal cord tuberculomas may be associated with localized or radicular pain, weakness, sensory loss, and incontinence. Tuberculomas may arise as OPPORTUNISTIC INFECTIONS, but also occur in immunocompetent individuals.
Concepts Disease or Syndrome (T047)
MSH D016862
ICD9 013.20, 013.2
SnomedCT 416265003, 40769007
English Intracranial Tuberculomas, Tuberculoma, Intracranial, Tuberculomas, Intracranial, Tuberculoma of brain, unspecified examination, intracranial tuberculoma, intracranial tuberculoma (diagnosis), Tuberculoma of brain (disorder), Tuberculoma of brain (finding), Intracranial Tuberculoma, Tuberculoma brain-unspec, Tuberculoma, Intracranial [Disease/Finding], Tuberculoma of brain, unspecified, brain of tuberculoma, tuberculoma of brain, brain tuberculoma, Tuberculoma of brain
Dutch hersentuberculoom, niet-gespecificeerd onderzoek, tuberculoom van de hersenen, Intracraniaal tuberculoom, Tuberculoom, intracraniaal
French Tuberculome du cerveau, Tuberculome du cerveau, examen non précisé, Tuberculome intracrânien
German Tuberkulom des Gehirns, Tuberkulom des Gehirns, unspezifische Untersuchung, Intrakranielles Tuberkulom, Tuberkulom, intrakranielles
Italian Tubercoloma dell'encefalo, Tubercoloma dell'encefalo, esame non specificato, Tubercoloma intracranico
Portuguese Tuberculoma cerebral com exame NE, Tuberculoma cerebral, Tuberculoma Intracraniano
Spanish Tuberculoma cerebral, Tuberculoma cerebral, estudio no especificado, tuberculoma cerebral (trastorno), tuberculoma cerebral (hallazgo), tuberculoma del cerebro, tuberculoma del cerebro (trastorno), tuberculoma cerebral, Tuberculoma Intracraneal
Japanese 脳結核腫、検査の詳細不明, 脳結核腫, ノウケッカクシュ, ノウケッカクシュケンサノショウサイフメイ, 頭蓋内結核腫, 頭蓋内結核腫(ズガイナイケッカクシュ), 結核腫-頭蓋内, 結核腫-頭蓋内(ズガイナイ)
Swedish Tuberkulom, intrakraniellt
Czech tuberkulom intrakraniální, Tuberkulom mozku, Tuberkulom mozku, blíže neurčené vyšetření
Finnish Kallonsisäinen tuberkulooma
Polish Gruźliczak wewnątrzczaszkowy
Hungarian Agyi tuberculoma, nem meghatározott vizsgálat, Agyi tuberculoma
Norwegian Intrakranialt tuberkulom

Ontology: Tuberculosis, Central Nervous System (C0275904)

Definition (MSH) Tuberculosis of the brain, spinal cord, or meninges (TUBERCULOSIS, MENINGEAL), most often caused by MYCOBACTERIUM TUBERCULOSIS and rarely by MYCOBACTERIUM BOVIS. The infection may be limited to the nervous system or coexist in other organs (e.g., TUBERCULOSIS, PULMONARY). The organism tends to seed the meninges causing a diffuse meningitis and leads to the formation of TUBERCULOMA, which may occur within the brain, spinal cord, or perimeningeal spaces. Tuberculous involvement of the vertebral column (TUBERCULOSIS, SPINAL) may result in nerve root or spinal cord compression. (From Adams et al., Principles of Neurology, 6th ed, pp717-20)
Concepts Disease or Syndrome (T047)
MSH D020306
ICD9 013.90, 013.9
SnomedCT 186224007, 10706006
English Unspecified tuberculosis of central nervous system, Tuberculosis of CNS NOS, Tuberculosis of central nervous system NOS, Unspecified tuberculosis of central nervous system, unspecified examination, TUBERCULOSIS CNS, CNS TUBERCULOSIS, central nervous system tuberculosis (diagnosis), central nervous system tuberculosis, CNS tuberculosis, Central Nervous System Tuberculosis, Tuberculosis, Central Nervous System, Cns TB NOS-unspec, Tuberculosis, Central Nervous System [Disease/Finding], Unspecified tuberculosis of central nervous system, unspecified, cns tuberculosis, Tuberculosis of central nervous system NOS (disorder), Tuberculosis of central nervous system, Tuberculosis of central nervous system (disorder), Tuberculosis of central nervous system, NOS
Dutch centraal zenuwstelseltuberculose NAO, niet-gespecificeerde tuberculose van het centraal zenuwstelsel, niet-gespecificeerd onderzoek, niet-gespecificeerde tuberculose van het centraal zenuwstelsel, centraal zenuwstelseltuberculose, Centrale zenuwstelsel, tuberculose van het, Tuberculose van het centrale zenuwstelsel, Zenuwstelsel, tuberculose van het centrale
French Tuberculose du système nerveux central SAI, Tuberculose non précisée du système nerveux central, examen non précisé, Tuberculose non précisée du système nerveux central, Tuberculose du système nerveux central, Tuberculose du SNC
German unspezifische Tuberkulose des Zentralnervensystems, unspezifische Untersuchung, unspezifische Tuberkulose des Zentralnervensystems, Tuberkulose des Zentralnervensystems NNB, Tuberkulose des Zentralnervensystems, Tuberkulose, Zentralnervensystem
Italian Tubercolosi del sistema nervoso centrale NAS, Tubercolosi non specificata del sistema nervoso centrale, Tubercolosi non specificata del sistema nervoso centrale, esame non specificato, Tubercolosi del sistema nervoso centrale
Portuguese Tuberculose do sistema nervoso central NE, Tuberculose NE do SNC, exame NE, Tuberculose NE do SNC, Tuberculose do sistema nervoso central, Tuberculose do Sistema Nervoso Central
Spanish Tuberculosis no especificada del sistema nervioso central, estudio no especificado, Tuberculosis no especificada del sistema nervioso central, Tuberculosis del sistema nervioso central NEOM, tuberculosis del sistema nervioso central, SAI (trastorno), tuberculosis del sistema nervioso central, SAI, tuberculosis del SNC, tuberculosis del sistema nervioso central (trastorno), tuberculosis del sistema nervioso central, Tuberculosis del sistema nervioso central, Tuberculosis del Sistema Nervioso Central
Japanese 中枢神経系結核NOS, 詳細不明の中枢神経系結核、検査の詳細不明, 詳細不明の中枢神経系結核, チュウスウシンケイケイケッカクNOS, ショウサイフメイノチュウスウシンケイケイケッカクケンサノショウサイフメイ, チュウスウシンケイケイケッカク, ショウサイフメイノチュウスウシンケイケイケッカク, 結核-中枢神経系, 中枢神経系結核
Swedish Tuberkulos, centrala nervsystemet
Czech tuberkulóza centrálního nervového systému, Blíže neurčená tuberkulóza centrálního nervového systému, blíže neurčené vyšetření, Tuberkulóza centrální nervové soustavy, Blíže neurčená tuberkulóza centrálního nervového systému, Tuberkulóza centrálního nervového systému NOS
Finnish Keskushermoston tuberkuloosi
Croatian Not Translated[Tuberculosis, Central Nervous System]
Polish Gruźlica OUN, Gruźlica ośrodkowego układu nerwowego
Hungarian nem meghatározott központi idegrendszeri tuberculosis, Nem meghatározott központi idegrendszeri tuberculosis, nem meghatározott vizsgálat, központi idegrendszeri tuberculosis, központi idegrendszeri tuberculosis k.m.n.
Norwegian Tuberkulose i sentralnervesystemet