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Tuberculosis, CNS

Matthew J. Putty, DO and Jason M. Seibly, DO, FACOS Reviewed 06/2018
 


BASICS

DESCRIPTION

  • A granulomatous infection of the brain, meninges, or spinal cord caused by Mycobacterium tuberculosis

  • Central nervous system tuberculosis (CNS TB) includes tuberculous meningitis, int...

DIAGNOSIS

HISTORY

  • Assess patient risk.

  • Malaise, fever, headache, vomiting

  • Confusion, seizures, altered mental status

PHYSICAL EXAM

  • Neurologic exam

    • Meningismus

    • Altered mental status/lethargy/coma

    • Papilledema

    • Cr...

TREATMENT

  • Early diagnosis improves outcomes.

  • Start treatment empirically if clinical suspicion is high. Delayed treatment can lead to fatal outcomes.

  • Treatment guidelines for CNS TB are based on pulmona...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Look for other foci of infection.

  • Institute seizure precautions.

  • Neuropsychological surveillance

  • Treat concurrent HIV infection, if present.

Patient Monitoring

  • Assess ...

REFERENCES

1
Thuong NT, Hawn TR, Thwaites GE, et al. A polymorphism in human TLR2 is associated with increased susceptibility to tuberculous meningitis. Genes Immun.  2007;8(5):422–428. [View Abst...

ADDITIONAL READING

  • DeLance AR, Safaee M, Oh MC, et al. Tuberculoma of the central nervous system. J Clin Neurosci.  2013;20(10):1333–1341.

  • Kadhiravan T, Deepanjali S. Role of corticosteroids in th...

CODES

ICD10

  • A17.9 Tuberculosis of nervous system, unspecified

  • A17.0 Tuberculous meningitis

  • A17.81 Tuberculoma of brain and spinal cord

  • A17.82 Tuberculous meningoencephalitis

  • A17.1 Meningeal tuberculoma

  • A17....

CLINICAL PEARLS

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