Central nervous system and spinal cord tuberculosis: Revisiting an important disease

Salvador, G.L. Oliveira; Basso, Ana Carolina Nicoletti; Barbieri, Poliana Palma; Leitão, Cleverson Alex; Teixeira, Bernardo Corrêa de Almeida; Neto, Arnolfo Carvalho

doi:10.1016/j.clinimag.2020.07.020

Cited by 21 publications

(15 citation statements)

References 76 publications

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“…Chest X-ray can be normal in 20-50% of cases; There is usually some evidence of pulmonary tuberculosis (hilar adenopathy, pneumonia or miliary tuberculosis). Computed tomography (CT) and nuclear magnetic resonance (MRI) of the brain are normal in the early stages of the disease, but as TBM progresses they may show increased basal contrast, communicating hydrocephalus, signs of cerebral edema, one or more clinically silent tuberculomas, most often in the cerebral cortex or thalamic regions [29,30].…”

Section: Imaging Exploration In Tbmmentioning

confidence: 99%

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Hydrocephalus in Tuberculous Meningitis

Caliman-Sturdza¹,

Cucu²

2023

Frontiers in Hydrocephalus

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Hydrocephalus is a frequent complication of tuberculous meningitis. We present the incidence of hydrocephalus in patients diagnosed with tuberculosis of the nervous system, the therapeutic possibilities and the evolution of these patients. A consensus definition for tuberculous meningitis (TBM) stratified the cases as definite, probable and possible. In various studies, radiological investigations (CT, MRI) can be normal in the initial stages of the disease in approximately 30% of cases, but they do not exclude the possibility of a TBM. The most common radiological changes found in TBM are communicating hydrocephalus (up to 80% of cases), increased basal contrast (50%), cerebral tuberculomas (30%) and cerebral infarcts (10–40%). MRI has been shown to be more sensitive than a CT scan for diagnosed TBM. Communicating hydrocephalus is among the short-term complications of TBM (approximately 80% of cases), being more frequent than non-communicating ones. In these cases, the need to perform a ventriculo-peritoneal unit must be taken into account. Long-term complications are cognitive impairment, epilepsy, stroke, hydrocephalus, myelitis, damage to the hypothalamus or the pituitary gland manifested by obesity, growth disorders and diabetes insipidus. Sequels may occur frequently in TBM such as dementia, epilepsy, neurological deficits, behavioral disorders, blindness and deafness.

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Section: Imaging Exploration In Tbmmentioning

confidence: 99%

“…Communicating hydrocephalus-80%; basal meningeal enhancement-75%; cerebral infarctions-8-44%; tuberculomas-8-31% [29,30].…”

Section: Imaging Exploration In Tbmmentioning

confidence: 99%

Hydrocephalus in Tuberculous Meningitis

Caliman-Sturdza¹,

Cucu²

2023

Frontiers in Hydrocephalus

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“…Up to 41% of patients with CNSTB display infarcts on imaging. [ 36 ] Whether this discrepancy is due to the under-recognition of spinal infarcts, or whether spinal vessels are less susceptible to obliterative endarteritis, is unclear.…”

Section: Linical P Resentationmentioning

confidence: 99%

Tuberculosis of the spinal cord

Manesh

Garg

Radhakrishnan

et al. 2023

Ann Indian Acad Neurol

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Tuberculosis involving the spinal cord is associated with high mortality and disabling long-term sequelae. Although tuberculous radiculomyelitis is the most frequent complication, pleomorphic clinical manifestations exist. Diagnosis can be challenging among patients with isolated spinal cord tuberculosis due to diverse clinical and radiological presentations. The principles of management of tuberculosis of the spinal cord are primarily derived from, and dependent upon, trials on tuberculous meningitis (TBM). Although facilitating mycobacterial killing and controlling host inflammatory response within the nervous system remain the primary objectives, several unique features require attention. The paradoxical worsening is more frequent, often with devastating outcomes. The role of anti-inflammatory agents such as steroids in adhesive tuberculous radiculomyelitis remains unclear. Surgical interventions may benefit a small proportion of patients with spinal cord tuberculosis. Currently, the evidence base in the management of spinal cord tuberculosis is limited to uncontrolled small-scale data. Despite the gargantuan burden of tuberculosis, particularly in lower and middle-income countries, large-scale cohesive data are surprisingly sparse. In this review, we highlight the varied clinical and radiological presentations, performance of various diagnostic modalities, summarize data on the efficacy of treatment options, and propose a way forward to improve outcomes in these patients.

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“…A presumptive diagnosis of tuberculoma is usually made on the basis of neuroimaging findings in combination with a compatible clinical history, supportive evidence of TB outside the CNS, and response to treatment 62 . Radiographic features depend on the stage of the granuloma, which can be noncaseating, caseating, caseating with central liquefication, or calcified ( table 8-3 63 ). The majority of tuberculomas are less than 1 cm in diameter with about 10% of lesions measuring 1 cm to 3 cm in diameter, although larger lesions are possible.…”

Section: Tuberculomas and Tuberculous Abscessesmentioning

confidence: 99%

mentioning

confidence: 99%

Neurologic Complications of Tuberculosis

Saylor¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW: This article describes the current epidemiology, common clinical characteristics, and up-to-date evidence-based approaches to the diagnosis and management of the most common neurologic complications of tuberculosis (TB): tuberculous meningitis, intracranial tuberculoma, and spinal TB.RECENT FINDINGS: Central nervous system (CNS) TB remains common and associated with significant mortality and neurologic sequelae worldwide. Human immunodeficiency virus (HIV) co-infection is strongly associated with both the development of and mortality due to CNS TB. Strongyloides co-infection is associated with reduced CNS inflammation and improved outcomes in the setting of tuberculous meningitis. Stroke remains a common complication of tuberculous meningitis, and emerging evidence suggests aspirin may be used in this context. Although a recent nucleic acid amplification test has demonstrated suboptimal sensitivity in the diagnosis of CNS TB, emerging diagnostic techniques include cell-free DNA, peripheral blood microRNA, metagenomic next-generation sequencing, and advanced imaging techniques, but these are not yet well validated. CNS TB is associated with high mortality even with current treatment regimens, although novel, promising strategies for treatment are under investigation, including a combination of IV isoniazid and ethambutol and high-dose rifampicin.SUMMARY: TB can affect the nervous system in various ways and is associated with high mortality. Diagnosis remains challenging in endemic settings, with empiric treatment often initiated without a definitive diagnosis. Furthermore, optimal treatment regimens remain uncertain because current treatment for all forms of CNS TB is extrapolated from trials of tuberculous meningitis whereas the role of steroids in people with HIV and tuberculous meningitis remains controversial.

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Central nervous system and spinal cord tuberculosis: Revisiting an important disease

Cited by 21 publications

References 76 publications

Hydrocephalus in Tuberculous Meningitis

Hydrocephalus in Tuberculous Meningitis

Tuberculosis of the spinal cord

Neurologic Complications of Tuberculosis

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