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Central nervous system tuberculosis: a forgotten diagnosis.

Abstract

INTRODUCTION
Early diagnosis and treatment of central nervous system (CNS) tuberculosis (TB) are very important because of its high morbidity and mortality characteristics. However, the clinical symptoms, laboratory and neuroimaging findings of CNS TB are nonspecific, no matter whether they are the common form, tuberculous meningitis (TBM), or the rare form, intracranial tuberculomas. We report a case of TBM with miliary pattern of intracranial tuberculomas, although the initial diagnosis was masked by an atypical neuropsychiatric presentation, cerebrospinal fluid (CSF) finding, and other medical comorbidity.
CASE REPORT
A 51-year-old man was brought to the emergency room due to a traffic accident. The initial impression was Wernicke encephalopathy due to his alcohol use history and the clinical triad. After admission, fever and mental confusion lead to the suspicion of CNS infection. Although the initial CSF analysis was inconclusive, the miliary pattern of intracranial tuberculomas was highly suspected by brain magnetic resonance imaging finding. The diagnosis of TBM and miliary TB was finally confirmed by positive CSF and sputum culture of Mycobacterium tuberculosis. The patient had a good response to standard antituberculous therapy, although paradoxical expansion of cerebral tuberculomas occurred during treatment.
CONCLUSIONS
TB is still a major public health problem in the world, and there is a rising tendency of extrapulmonary TB incidences in the developed countries. Because of the high mortality and treatable characteristics of CNS TB, physicians should be familiar with it and keep the diagnosis in mind.

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  • Publisher Full Text

    • Authors

    Chou PS, Liu CK, Lin RT, Lai CL, Chao AC

    Institution

    Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.

    Source

    The neurologist 18:4 2012 Jul pg 219-22

    MeSH

    Antitubercular Agents
    Brain
    Humans
    Magnetic Resonance Imaging
    Male
    Middle Aged
    Tuberculosis, Central Nervous System

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    22735252