Makindo Medical Notes.com

Blood spread to the brain forms a Rich focus which can rupture into brain material

About

• Insidious onset. Early diagnosis needed.

Tuberculous involvement of CNS

• Tuberculous meningitis
• Tuberculomas - behave like space-occupying lesions
• Spinal Arachnoiditis
• TB arteritis causing stroke-like findings
• VI nerve palsy and Hydrocephalus

Aetiology

• Recent TB exposure, Alcohol, Immunosuppression

Stages

• Stage I: Conscious, rational with no focal signs or hydrocephalus
• Stage II: Confusion +/- focal signs
• Stage III: Coma, delirium, hemiparesis, paraplegia

Clinical

• Often a basal meningitis and optic chiasm
• Localised vasculitis with thrombosis and haemorrhage
• Impaired CSF resorption and flow and hydrocephalus
• Aqueduct can become blocked by high protein CSF
• Lymphadenopathy, Splenomegaly

Clinical

• Malaise, fever, headache for 2-3 weeks
• Meningism, vomiting, confusion, cranial nerve palsies
• IIIrd nerve and VI palsies
• Stupor, coma, seizures

Investigations

• FBC, U&E, LFTs, CRP, ESR elevated
• Mantoux test positive in only 50%
• CSF : High protein 1-5 g/l and low glucose. Increased lymphocytes though polymorphs seen initially. AFB staining may be negative. Cultures take 6 weeks. PCR can be used.
• CT Brain often normal. With signs, there is hydrocephalus and basal enhancement due to exudates. Intracerebral tuberculomas may be seen.
• HIV testing in all cases

Management

• Anti tuberculous therapy using four antituberculous drugs
• Steroids may be useful with raised ICP, cerebral oedema, focal deficits and hydrocephalus. Shunting may be needed for hydrocephalus
• HAART if AIDS diagnosis