Skip to main content
Elsevier - PMC COVID-19 Collection logoLink to Elsevier - PMC COVID-19 Collection
. 2018 Jun 5;4(1):143–158. doi: 10.1016/S0733-8619(18)30992-7

CNS Tuberculosis

James R Sheller *,**, Roger M Deg Prez
PMCID: PMC7134635  PMID: 3523199

Abstract

Tuberculous meningitis is a subacute meningitis in which early therapy significantly improves outcome. Atypical features abound, and the diagnosis must be entertained in a variety of situations. CT scanning has improved our knowledge of the disease and may help in diagnosis.

References

  • 1.Auerbach A. Tuberculous meningitis: Correlation of therapeutic results with pathogenesis and pathologic changes, general considerations and pathogenesis. Am. Rev. Tuberc. 1951;64:408–418. doi: 10.1164/art.1951.64.4.408. [DOI] [PubMed] [Google Scholar]
  • 2.Bhargava S., Gupta A.K., Tandon P.N. Tuberculous meningitis: A CT study. Br. J. Radiol. 1982;55:189–196. doi: 10.1259/0007-1285-55-651-189. [DOI] [PubMed] [Google Scholar]
  • 3.Bobrowitz I.D. Ethambutol in tuberculous meningitis. Chest. 1972;61:629–632. doi: 10.1378/chest.61.7.629. [DOI] [PubMed] [Google Scholar]
  • 4.British Thoracic Association. A controlled trial of six months chemotherapy in pulmonary tuberculosis. Br. J. Dis. Chest. 1981;75:141–153. doi: 10.1016/0007-0971(81)90046-2. [DOI] [PubMed] [Google Scholar]
  • 5.Bullock M.R.R., Welchman J.M. Diagnostic and prognostic features of tuberculous meningitis on CT scanning. J. Neurol. Neurosurg. Psychiatry. 1982;45:1098–1101. doi: 10.1136/jnnp.45.12.1098. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Citron K.M. Ethambutol: A review with special reference to ocular toxicity. Tubercle. 1969;50(Suppl.):32–36. doi: 10.1016/0041-3879(69)90079-8. [DOI] [PubMed] [Google Scholar]
  • 7.Crowson T.W., Rich E.C., Woolfrey B.F. Overutilization of cultures of CSF for mycobacteria. J.A.M.A. 1984;251(1):70–72. [PubMed] [Google Scholar]
  • 8.Dastur D.K., Lalitha V.S. The many facets of neuro tuberculosis: An epitome of neuropathology. In: Zimmerman H.M., editor. Progress in Neuropathology. Grune & Stratton; New York: 1973. pp. 351–408. Vol. 2. [Google Scholar]
  • 9.Des Prez R., Boone I.U. Metabolism of C14-Isoniazid in humans. Am. Rev. Respir. Dis. 1961;84:42–51. doi: 10.1164/arrd.1961.84.1.42. [DOI] [PubMed] [Google Scholar]
  • 10.D’Oliveira J.J.G. Cerebrospinal fluid concentrations of rifampin in meningeal tuber culosis. Am. Rev. Respir. Dis. 1972;106:432–437. doi: 10.1164/arrd.1972.106.3.432. [DOI] [PubMed] [Google Scholar]
  • 11.Escobar J.A., Belsey M.A., Duenas A. Mortality from tuberculous meningitis reduced by steroid therapy. Pediatrics. 1975;56:1050–1055. [PubMed] [Google Scholar]
  • 12.Falk A. U.S. Veterans Administration Armed Forces cooperative study on the chemo therapy of tuberculosis: XIII. Tuberculous meningitis in adults with special reference to survival, neurologic residuals, and work status. Am. Rev. Respir. Dis. 1965;91:823–831. doi: 10.1164/arrd.1965.91.6.823. [DOI] [PubMed] [Google Scholar]
  • 13.Fischl M.A., Pitchenik A.E., Spira T.J. Tuberculous brain abscess and Toxoplasma encephalitis in a patient with the acquired immunodeficiency syndrome. J.A.M.A. 1985;253:3428–3430. [PubMed] [Google Scholar]
  • 14.Forgan-Smith R., Eiland G.A., Newton D. Pyrazinamide and other drugs in tuberculous meningitis. Lancet. 1973;2:374. doi: 10.1016/s0140-6736(73)93211-x. [DOI] [PubMed] [Google Scholar]
  • 15.Fox W. Whither short-course chemotherapy? Br. J. Dis. Chest. 1981;75:331–357. doi: 10.1016/0007-0971(81)90022-x. [DOI] [PubMed] [Google Scholar]
  • 16.Geisler P.J., Manis R.D., Jr., Maddus M.S. Dosage of antituberculous drugs in obese patients. Am. Rev. Resp. Dis. 1985;131:944–946. doi: 10.1164/arrd.1985.131.6.944. [DOI] [PubMed] [Google Scholar]
  • 17.Gersternbrand F., Gellinger K., Marda F. Symptomatology of the most severe form of tuberculous meningitis. J. Neurol. 1980;222:191–204. doi: 10.1007/BF00313118. [DOI] [PubMed] [Google Scholar]
  • 18.Gokalp H.Z., Ozkal E. Intradural tuberculomas of the spinal cord: Report of two cases. J. Neurosurg. 1981;55:289–292. doi: 10.3171/jns.1981.55.2.0289. [DOI] [PubMed] [Google Scholar]
  • 19.Gourie-Devi M., Satish P. Hyaluronidase as an adjuvant in the treatment of cranial arachnoiditis (hydrocephalus and optochiasmatic arachnoiditis) complicating tuberculous meningitis. Acta Neurol. Scand. 1980;62:361–368. doi: 10.1111/j.1600-0404.1980.tb03049.x. [DOI] [PubMed] [Google Scholar]
  • 20.Harder E., Al-Kawi M.Z., Carney P. Intracranial tuberculoma: Conservative management. Am. J. Med. 1983;74:570–576. doi: 10.1016/0002-9343(83)91011-2. [DOI] [PubMed] [Google Scholar]
  • 21.Hernandez R., Munoz O., Guiscafre H. Sensitive enzyme immunoassay for early diagnosis of tuberculosis meningitis. J. Clin. Microbiol. 1984;20:533–535. doi: 10.1128/jcm.20.3.533-535.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Hildebrandt G., Agnoli A.L. Differential diagnosis and therapy of intracerebral tuberculomas. J. Neurol. 1982;228:201–208. doi: 10.1007/BF00313733. [DOI] [PubMed] [Google Scholar]
  • 23.Hinman A.R. Tuberculous meningitis at Cleveland Metropolitan General Hospital 1959 to 1963. Am. Rev. Resp. Dis. 1967;95:670–673. doi: 10.1164/arrd.1967.95.4.670. [DOI] [PubMed] [Google Scholar]
  • 24.Idriss Z.H., Sinno A.A., Kronfol N.M. Tuberculous meningitis in childhood: Forty-three cases. Am. J. Dis. Child. 1976;130:364–367. doi: 10.1001/archpedi.1976.02120050022004. [DOI] [PubMed] [Google Scholar]
  • 25.Illingsworth R.S. Miliary and meningeal tuberculosis: Difficulties in diagnosis. Lancet. 1956;2:646–649. doi: 10.1016/s0140-6736(56)92336-4. [DOI] [PubMed] [Google Scholar]
  • 26.Jeren T., Beus I. Characteristics of cerebrospinal fluid in tuberculous meningitis. Int. Acad. Cytol. 1982;26:678–680. [PubMed] [Google Scholar]
  • 27.Kalish S.B., Radin R.C., Levitz D. The enzyme-linked immunosorbent assay method for IgG antibody to purified protein derivative in cerebrospinal fluid of patients with tuberculosis meningitis. Ann. Intern. Med. 1983;99:630–633. doi: 10.7326/0003-4819-99-5-630. [DOI] [PubMed] [Google Scholar]
  • 28.Karandanis D., Shulman J.A. Recent survey of infectious meningitis in adults: Review of laboratory findings in bacterial, tuberculous and aseptic meningitis. South. Med. J. 1976;69:449–457. doi: 10.1097/00007611-197604000-00021. [DOI] [PubMed] [Google Scholar]
  • 29.Kaufman D.M., Kaplan J.G., Litman N. Infectious agents in spinal epidural abscesses. Neurology. 1980;30:844–850. doi: 10.1212/wnl.30.8.844. [DOI] [PubMed] [Google Scholar]
  • 30.Kennedy D.H., Fallon R.J. Tuberculous meningitis. J.A.M.A. 1979;241:264–268. [PubMed] [Google Scholar]
  • 31.Kocen R.S., Parsons M. Neurological complications of tuberculosis: Some unusual manifestations. Q. J. Med. 1970;39:17–30. [PubMed] [Google Scholar]
  • 32.Latorre P., Gallofre M., Laporte J.-R. Rifampicin in tuberculosis meningitis: A retrospective assessment. Eur. J. Clin. Pharmacol. 1984;26:583–586. doi: 10.1007/BF00543489. [DOI] [PubMed] [Google Scholar]
  • 33.Lin T.H. Intramedullary tuberculoma of the spinal cord. J. Neurosurg. 1960;17:497–499. doi: 10.3171/jns.1960.17.3.0497. [DOI] [PubMed] [Google Scholar]
  • 34.Lorber J. Studies of the cerebrospinal fluid circulation in tuberculous meningitis in children. Part II: A review of 100 pneumoencephalograms. Arch. Dis. Child. 1951;26:28–44. doi: 10.1136/adc.26.125.28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Loizou L.A., Anderson M. Intracranial tuberculomas: Correlation of computerized tomography with clinico-pathological findings. Q. J. Med. 1982;51:104–114. [PubMed] [Google Scholar]
  • 36.Mahanta A., Kaira L., Maheshwari M.D. Brain-stem tuberculoma: An unusual presentation. J. Neurol. 1982;227:249–253. doi: 10.1007/BF00313392. [DOI] [PubMed] [Google Scholar]
  • 37.Molavi A., LeFrock J.L. Tuberculous meningitis. Med. Clin. North Am. 1985;69:315–331. doi: 10.1016/s0025-7125(16)31045-8. [DOI] [PubMed] [Google Scholar]
  • 38.Munt P.W. Miliary tuberculosis in the chemotherapy era: With a clinical review in 69 American adults. Medicine. 1972;51:139–155. doi: 10.1097/00005792-197203000-00004. [DOI] [PubMed] [Google Scholar]
  • 39.O’Toole R.D., Thornton G.F., Mukherjee M.K. Dexamethasone in tuberculous meningitis: Relationship of cerebrospinal fluid effects to therapeutic efficacy. Ann. Intern. Med. 1969;70:39–47. doi: 10.7326/0003-4819-70-1-39. [DOI] [PubMed] [Google Scholar]
  • 40.Rahajoe N.N., Rahajoe N., Boediman I. The treatment of tuberculous meningitis in children with a combination of isoniazid, rifampicin and streptomycin: Preliminary report. Tubercle. 1979;60:245–250. doi: 10.1016/0041-3879(79)90006-0. [DOI] [PubMed] [Google Scholar]
  • 41.Rahman N.U. Atypical forms of spinal tuberculosis. J. Bone Joint Surg. 1980;62:162–165. doi: 10.1302/0301-620X.62B2.7364827. [DOI] [PubMed] [Google Scholar]
  • 42.Reichenthal E., Cohen M.L., Schujman E. Tuberculous brain abscess and its appearance on computerized tomography. J. Neurosurg. 1982;56:597–600. doi: 10.3171/jns.1982.56.4.0597. [DOI] [PubMed] [Google Scholar]
  • 43.Rich A.R., McCordock H.A. Pathogenesis of tuberculous meningitis. Bull. Johns Hopkins Hosp. 1933;52:5–37. [Google Scholar]
  • 44.Sada E., Ruiz-Palacios G.M., Lopez-Vidal Y. Detection of mycobacterial antigens in cerebrospinal fluid of patients with tuberculous meningitis by enzyme-linked immunosorbent assay. Lancet. 1983;2:651–652. doi: 10.1016/s0140-6736(83)92532-1. [DOI] [PubMed] [Google Scholar]
  • 45.Sandyk R., Brennan M.J.W. Internuclear ophthalmoplegia in tuberculous meningitis. Eur. Neurol. 1984;23:148–150. doi: 10.1159/000115695. [DOI] [PubMed] [Google Scholar]
  • 46.Sippel J.E., Mikhail I.A., Girgis N.I.L. Rifampin concentrations in cerebrospinal fluid of patients with tuberculous meningitis. Am. Rev. Respir. Dis. 1974;109:579–580. doi: 10.1164/arrd.1974.109.5.579. [DOI] [PubMed] [Google Scholar]
  • 47.Slavin R.E., Walsh T.J., Pollack A.D. Late generalized tuberculosis: A clinical pathologic analysis of 100 cases in the preantibiotic and antibiotic eras. Medicine. 1980;59:352–366. [PubMed] [Google Scholar]
  • 48.Smith A.L. Tuberculous meningitis in childhood. Med. J. Aust. 1975;1:57–60. doi: 10.5694/j.1326-5377.1975.tb111231.x. [DOI] [PubMed] [Google Scholar]
  • 49.Smith H.V. Tuberculous meningitis. Int. J. Neurol. 1967;4:134–157. [PubMed] [Google Scholar]
  • 50.Smith J., Godwin-Austen R. Hypersecretion of anti-diuretic hormone due to tuberculous meningitis. Postgrad. Med. J. 1980;56:41–44. doi: 10.1136/pgmj.56.651.41. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Stead W.W., Lofgren J.P., Warren E. Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes. N. Engl. J. Med. 1985;312:1483–1487. doi: 10.1056/NEJM198506063122304. [DOI] [PubMed] [Google Scholar]
  • 52.Stevens D.L., Everett E.D. Sequential computerized axial tomography in tuberculous meningitis. J.A.M.A. 1978;239:642. [PubMed] [Google Scholar]
  • 53.Stewart S.M. The bacteriologic diagnosis of tuberculous meningitis. J. Clin. Pathol. 1953;6:241–242. doi: 10.1136/jcp.6.3.241. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 54.Stockstill M.T., Kauffman C.A. Comparison of cryptococcal and tuberculous meningitis. Arch. Neurol. 1983;40:81–85. doi: 10.1001/archneur.1983.04050020043008. [DOI] [PubMed] [Google Scholar]
  • 55.Tandon P.N., Rao M.A.P., Banerji A.K. Isotope scanning of the cerebrospinal fluid pathways in tuberculous meningitis. J. Neurol. Sci. 1975;25:401–412. [Google Scholar]
  • 56.Taylor K.B., Smith H.V., Vollum R.L. Tuberculous meningitis of acute onset. J. Neurol. Neurosurg. Psychiatry. 1955;18:165–173. doi: 10.1136/jnnp.18.3.165. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 57.Traub M., Colchester A.C.F., Kingsley D.P.E. Tuberculosis of the central nervous system. Q. J. Med. 1984;209:81–100. [PubMed] [Google Scholar]
  • 58.Trautmann M., Lindner O., Haase C. Focal tuberculous meningoencephalitis. Eur. Neurol. 1983;22:417–420. doi: 10.1159/000115595. [DOI] [PubMed] [Google Scholar]
  • 59.Udani P.M., Dastur D.K. Tuberculous encephalopathy with and without meningitis: Clinical features and pathological correlations. J. Neurol. Sci. 1970;10:541–561. doi: 10.1016/0022-510x(70)90187-5. [DOI] [PubMed] [Google Scholar]
  • 60.Udani P.M., Parekh U.C., Dastur D.K. Neurological and related syndromes in CNS tuberculosis. Clinical features and pathogenesis. J. Neurol. Sci. 1971;14:341–357. doi: 10.1016/0022-510x(71)90222-x. [DOI] [PubMed] [Google Scholar]
  • 61.Van Beusekom G.T. Complications in hydrocephalus shunting procedure. In: Wullenbur R., Brock M., Klinger M., editors. Advances in Neurosurgery. Ed. 6. Springer-Verlag; New York: 1978. pp. 28–30. [Google Scholar]
  • 62.Wadia N.J., Dastur D.K. Spinal meningitis with radiculo-myelopathy. Part 1: Clinical and radiological features. J. Neurol. Sci. 1969;8:239–260. doi: 10.1016/0022-510x(69)90112-9. [DOI] [PubMed] [Google Scholar]
  • 63.Witham R.R., Johnson R.H., Roberts D.L. Diagnosis of miliary tuberculosis by cerebral computerized tomography. Arch. Intern. Med. 1979;139:479–480. [PubMed] [Google Scholar]

Articles from Neurologic Clinics are provided here courtesy of Elsevier

RESOURCES