Cerebral abscesses of tuberculosis origin: study of 8 cases at the University Hospital of Conakry

Abstract

Introduction Tuberculosis of the central nervous system (CNS) remains endemic in developing countries with high morbidity and mortality despite advances in imaging and treatment. The objective of our work was to describe the diagnostic and therapeutic difficulties of this pathology in the context of a country with limited health resources. Materials and methods We retrospectively studied 8 cerebral tuberculosis abscess files, collected in the archives of the neurosurgery department of the Conakry University Hospital over a 5-year period (January 2013–December 2017). The diagnosis was made by scanning and by isolation of acid-fast bacilli (AFB) by direct examination of pus. Results Mean age was 33 years (9–56 years), sex, 5H 5 men/3F 3 women. History of pulmonary TB, 3 cases; TB contagious, 5 cases; TST ITR positive, 5 cases; associated visceral TB, 5 cases; HIV positive serology, 2 cases. The clinic was dominated by altered consciousness, 7 cases; focal signs, 7 cases; and fever, 5 cases. The site was hemispherical in 7 cases and one case in the posterior brain fossa. Treatment was medico-surgical in all patients. The evolution was favorable in 3 cases, the neurological sequelae in 3 cases, 2 cases of death, and 2 cases of recurrence. Conclusion Cerebral tuberculous abscesses constitute a medico-surgical emergency. Despite their rarity, morbidity and mortality remains high in the context of developing countries due to diagnostic and therapeutic delays.

Magnetic resonance imaging findings in central nervous system tuberculosis: A pictorial review

“…Clinically, the patients present with focal neurological deficits, features of raised intracranial pressure, and fever. According to Whitner criteria, to call any lesion a tuberculous abscess; there should be macroscopic evidence of pus in brain parenchyma; the abscess wall should have vascular granulation tissue containing acute and chronic inflammatory cells and tuberculous bacilli should be present in culture or histology [ 62 ]. In imaging, these lesions are usually large (>3 cm size), multiloculated with thin enhancing walls, demonstrate profound perilesional edema, and surrounding mass effect [ 5 , 26 , 53 ].…”