Cases Of Central Nervous System Tuberculosis Research Articles

Drug Resistance in Children with Central Nervous System Tuberculosis from a Tertiary Care Center in Mumbai

Central Nervous System tuberculosis (CNS-TB) is the most lethal form of extra-pulmonary TB, especially in children. In this study, we have discussed patterns of drug resistance in pediatric CNS-TB. Prospective observational study conducted on 100 children at a tertiary care center. Diagnosed cases of CNS-TB were enrolled. GeneXpert MTB/RIF was used upfront for diagnosis, and in cases where TB MGIT culture was positive, a phenotypic Drug Susceptibility Test (DST) was done. Patients were divided into resistant to at least one drug (DR) and drug-susceptible (DS). Various parameters were compared between these groups. Mean age of participants was 5.84 ± 3.5 years, with a male-to-female ratio of 1.08 : 1; 14% of children had drug-resistant CNS TB (DR-CNS-TB). A higher proportion of children previously treated for TB were associated with drug resistance (p = 0.009), and those with disseminated TB also had a higher drug resistance (p = 0.002). Apart from this, the DR and DS groups had no statistically significant differences in demographic, clinical or epidemiological parameters. Previous history of being treated for TB and disseminated TB was an independent risk factor for DR-CNS-TB. Ensuring proper adherence and compliance to anti-tubercular treatment could help in preventing the emergence of DR TB.

Central nervous system tuberculosis: Rare presentations of a common disease

Tuberculosis (TB) is a highly prevalent disease in developing countries of the world such as India. Central nervous system (CNS) involvement by TB can produce devastating effects and can be parenchymal, meningeal, intraventricular, subdural, or extradural. Common modes of CNS involvement include leptomeningitis and intracranial tuberculomas. Similar involvement of the spinal cord can produce tubercular arachnoiditis and intramedullary spinal tuberculomas. Atypical locations of tuberculomas include basal ganglia, brainstem, corpus callosum, and extra-axial and suprasellar locations. Uncommon modes of CNS involvement include tubercular pachymeningitis, focal tubercular cerebritis, cerebral abscess formation, and miliary TB. Tubercular pachymeningitis can also involve the dural lining of the spinal cord. We have presented cases of CNS TB, both atypical forms of common presentations as well as uncommon presentations with findings on magnetic resonance imaging (MRI) presenting a diagnostic dilemma. The radiologist plays a central role in the diagnosis of CNS TB in such cases, and careful tailoring of the MRI examination based on the clinical picture of the patient can play a vital role in making the diagnosis, even in atypical presentations.

Tumour-like presentation of central nervous system tuberculosis: A retrospective study in Kingdom of Saudi Arabia

Abstract Objective To differentiate the tumour-like presentation of central nervous system (CNS) tuberculosis (TB) from CNS tumours. Methods We conducted a retrospective chart review of all cases of CNS TB seen at King Abdulaziz Medical City, Jeddah, between January 2002 and January 2012. No symptoms or signs of pulmonary or systemic TB were found. Of the 125 patients with CNS TB, 9 (7.2%) presented with clinical and radiological features suggestive of a brain tumour. Results A diagnosis of tuberculoma was established either intraoperatively in frozen sections (three patients) or postoperatively when the masses were resected (six patients). After surgery, seven patients recovered after receiving anti-TB treatment; one patient died, and another developed a severe neurological deficit. Conclusion CNS TB is a great mimicker of brain tumours, and the index of suspicion should be high, especially in endemic areas. A diagnosis is based on clinical presentation and the results of investigations. In patients with CNS TB that present with a mass lesion, a biopsy should be taken to avoid morbidity and mortality from an unnecessary surgical intervention. Greater use should be made of magnetic resonance spectroscopy in the evaluation of brain space-occupying lesions, and CNS TB should be included in the differential diagnosis of such lesions in all areas endemic for TB. The absence of constitutional or pulmonary symptoms of TB is deceiving. More nationwide epidemiological studies are needed to establish guidelines for early detection and successful outcomes of this rising health problem.

TUBERCULAR MENINGITIS WITH CONCURRENT INTRACRANIAL AND INTRA-SPINAL TUBERCULOMAS

Central nervous system (CNS) tuberculosis commonly manifests as tubercular meningitis CNS tuberculomas are more common intracranially and less frequently involve the spinal cord. We report an unusual case of CNS tuberculosis presented with predominant features of tubercular meningitis with concurrent intra-cranial and intra-medullary tuberculomas in any evidence of pulmonary disease. Most noticeable feature of this patient was lower motor neuron type of bladder involvement in the beginning of clinical deterioration that led to the discovery of intra-spinal tuberculoma.

Cerebral tuberculosis with expansion into brainstem tuberculoma

There are only scattered case reports of intracranial tuberculosis in industrialized nations; brainstem tuberculoma is even more unusual, accounting for 2.5% to 8% of all intracranial tuberculoma. In developing nations, however, central nervous system tuberculosis (CNS-TB) is not rare and intracranial tuberculoma may account for 5% to 30% of all intracranial masses. The authors present two cases of CNS-TB with expansion to brainstem tuberculoma in patients who were undergoing treatment and had no known prior exposure to Mycobacterium tuberculosis.