Central Nervous System Tuberculosis

Bano, Shahina; Chaudhary, Vikas; Yadav, Sachchidanand

doi:10.5772/24964

Cited by 6 publications

(9 citation statements)

References 45 publications

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“…At any age, TBM is one of the most severe extra-pulmonary manifestations of TB, with high short-term mortality and substantial excess morbidity among survivors: approximately one-third of the affected individuals die of the disease and up to one-half of the survivors remain with serious neurological sequels, despite the initiation of anti-tuberculosis therapy [43][44]48,58,61]. Early, accurate diagnosis and prompt, adequate treatment are crucial in determining the clinical outcome of TBM [43,53,56,59,62]. If left untreated, TBM usually leads to death within 4-6 weeks after the onset of its symptoms [63]; nonetheless, in some cases [e.g., [64][65][66][67][68][69][70], the disease has a protracted course that can last for several months or even years.…”

Section: Plos Onementioning

confidence: 99%

Tracking down the White Plague: The skeletal evidence of tuberculous meningitis in the Robert J. Terry Anatomical Skeletal Collection

et al. 2020

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Paleopathological diagnosis of tuberculosis (TB) essentially relies on the identification of macroscopic lesions in the skeleton that can be related to different manifestations of TB. Among these alterations, granular impressions (GIs) on the inner skull surface have been considered as pathognomonic features of tuberculous meningitis (TBM). GIs may be established by pressure atrophy of the tubercles formed on the outermost meningeal layer during later stages of TBM. Although GIs were used as diagnostic criteria for TBM in the paleopathological practice since the late 20 th century, their diagnostic value has been questioned. To contribute to strengthening the diagnostic value of GIs, a macroscopic investigation-focusing on the macromorphological characteristics and frequency of GIs-was performed on skeletons of known cause of death from the Terry Collection. The χ 2 analysis of our data revealed that GIs were significantly more common in individuals who died of TB than in individuals who died of non-TB causes. Furthermore, GIs were localized on the inner surface of the skull base and of the lower lateral skull vault. The localization pattern and distribution of GIs on the endocranial surface resemble that of the tubercles observed in the affected meninges during the pathogenesis of TBM. Our results strengthen the tuberculous origin of GIs and imply that they can be considered as specific signs of TBM. Therefore, GIs can be used as diagnostic criteria for TBM in the paleopathological practice, and the diagnosis of TBM can be established with a high certainty when GIs are present in ancient human bone remains.

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Section: Plos Onementioning

confidence: 99%

Tracking down the White Plague: The skeletal evidence of tuberculous meningitis in the Robert J. Terry Anatomical Skeletal Collection

et al. 2020

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“…leptomeningitis tuberculosa, is the most common form of central nervous system (CNS) TB, accounting for about 70-80% of the cases [54][55][56][57][58][59][60]. TBM usually develops subsequent to the rupture of one or more meningeal, subpial, and/or subependymal caseating tubercles into the subarachnoid space or into the ventricular system, both occupied by the cerebrospinal fluid (CSF) [54][55][57][58][59][60][61][62][63][64][65][66][67][68][69]. The release of sufficient numbers of TB bacteria into the CSF triggers the onset of diffuse granulomatous inflammation of the leptomeninges, with strong predilection for the basal areas of the brain [54][55]62,[65][66][67][68]70].…”

Section: Plos Onementioning

confidence: 99%

“…Nonetheless, not only the pia and arachnoid mater but additionally, the outermost meningeal layer (i.e., the dura mater) can be affected by the disease [71]. Besides the small tubercles primarily formed in the leptomeninges and later also in the dura mater, characteristic pathological features of TBM include enhancing basal meningeal exudate, progressive hydrocephalus, and vasculitis of the blood vessels adjacent to or traversing the exudate [57,[59][60]62,64,67,[69][70][71]. In TBM, not only the intracranial arteries and veins but also the meningeal vessels and dural venous sinuses can become inflamed, occasionally resulting in hemorrhages [72][73].…”

Section: Plos Onementioning

confidence: 99%

Tracking down the White Plague. Chapter two: The role of endocranial abnormal blood vessel impressions and periosteal appositions in the paleopathological diagnosis of tuberculous meningitis

et al. 2020

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Although endocranial abnormal blood vessel impressions (ABVIs) and periosteal appositions (PAs) have been considered as paleopathological diagnostic criteria for tuberculous meningitis (TBM) based on findings of previous studies, they are not pathognomonic for tuberculosis (TB). Therefore, their utilization in the paleopathological practice can be questioned, especially in consideration that most of the previous studies were not performed on identified skeletal collections but on osteoarchaeological material and did not include statistical data analysis. To fill the aforementioned research gap, for the first time, a macroscopic investigation was conducted on identified pre-antibiotic era skeletons from the Terry Collection. A sample set of 234 individuals who died of TB (TB group) and 193 individuals who died of non-tuberculous causes (NTB group) were examined. The frequency of ABVIs and PAs, as well as other probable TB-related lesions was recorded. To determine the significance of difference (if any) in the frequencies of ABVIs and PAs between the two groups, χ 2 testing of our data was performed. We found that ABVIs, PAs, and their co-occurrence with each other and with other probable TB-related lesions were more common in the TB group than in the NTB group. In addition, the χ 2 comparative frequencies of ABVIs and PAs revealed a statistically significant difference between individuals who died of TB and individuals who died of NTB causes. Our findings strengthen those of previous studies that ABVIs and PAs are not specific to TBM but can be of tuberculous origin. Therefore, they do have a diagnostic value in the identification of TB in human osteoarchaeological material, especially when they simultaneously occur with other probable TB-related lesions. Their prudent utilization provides paleopathologists with a stronger basis for diagnosing TB and consequently, a more sensitive means of assessing TB frequency in past human populations.

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“…Clinical manifestations of CNS TB vary from meningitis, basilar arachnoiditis, tuberculoma, and encephalitis owing to devastating vasculopathy 2 . Tuberculous hypophysitis is a rare entity 3 , and secondary central insipidus diabetes due to sellar-suprasellar tuberculomas has been described elsewhere 3 . In 2015, the TB incidence rate in Brazil was 33.2 cases/100,000 inhabitants.…”

Section: Introductionmentioning

confidence: 99%

Diabetes insipidus secondary to tuberculous meningoencephalitis with hypothalamic involvement extending to the hypophysis: a case report

Santana

João

Lacerda

et al. 2018

Rev. Soc. Bras. Med. Trop.

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Central Nervous System Tuberculosis

Cited by 6 publications

References 45 publications

Tracking down the White Plague: The skeletal evidence of tuberculous meningitis in the Robert J. Terry Anatomical Skeletal Collection

Tracking down the White Plague: The skeletal evidence of tuberculous meningitis in the Robert J. Terry Anatomical Skeletal Collection

Tracking down the White Plague. Chapter two: The role of endocranial abnormal blood vessel impressions and periosteal appositions in the paleopathological diagnosis of tuberculous meningitis

Diabetes insipidus secondary to tuberculous meningoencephalitis with hypothalamic involvement extending to the hypophysis: a case report

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