Pulmonology Book

Tuberculosis

  • Central Nervous System Tuberculosis

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Central Nervous System Tuberculosis

Aka: Central Nervous System Tuberculosis, Tuberculous Meningitis, Intracranial Tuberculoma, Spinal Tuberculous Arachnoiditis
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  1. Distribution
    1. Tuberculous Meningitis (most common)
      1. Results from extension of tuberculoma
    2. Intracranial Tuberculoma
    3. Spinal Tuberculous Arachnoiditis
  2. Symptoms: Tuberculous Meningitis
    1. Initial phase lasts ~2 weeks
      1. Prodromal malaise, fever and Headache
      2. Personality changes may be seen
    2. Later
      1. Severe Headache
      2. Vomiting
      3. Confusion
    3. Final
      1. Coma
  3. Signs: Tuberculous Meningitis
    1. Cranial Nerve palsy
    2. Communicating Hydrocephalus
    3. Focal neurologic deficit
    4. Altered Level of Consciousness
    5. Meningeal signs
  4. Labs: CSF
    1. CSF Lymphcytes: 100-500 cells/ul
    2. CSF Protein: 100-500 mg/dl or higher
    3. CSF Glucose: <45 mg/dl
    4. Xanthochromia
    5. CSF Adenosine deaminase increased
    6. CSF Diagnosis
      1. CSF AFB smear
        1. Test Sensitivity varies up to 90%
        2. Increase sensitivity with 2-3 large volume taps
      2. CSF Culture for Mycobacterium tuberculosis
        1. Test Sensitivity varies up to 90%
        2. Requires up to 6 weeks for results
      3. Do not use CSF PCR for diagnosis (low yield)
  5. Imaging
    1. CT Head
  6. Management
    1. See Extrapulmonary Tuberculosis
    2. Start empiric treatment if suspected
    3. Antituberculous drugs for 9-12 months
    4. Use concurrent Dexamethasone for first 6-8 weeks
  7. References
    1. Donald (2004) N Engl J Med 351:1719-20

Intracranial Tuberculoma (C0085388)

Definition (MSH) A well-circumscribed mass composed of tuberculous granulation tissue that may occur in the cerebral hemispheres, cerebellum, brain stem, or perimeningeal spaces. Multiple lesions are quite common. Management of intracranial manifestations vary with lesion site. Intracranial tuberculomas may be associated with SEIZURES, focal neurologic deficits, and INTRACRANIAL HYPERTENSION. Spinal cord tuberculomas may be associated with localized or radicular pain, weakness, sensory loss, and incontinence. Tuberculomas may arise as OPPORTUNISTIC INFECTIONS, but also occur in immunocompetent individuals.
Concepts Disease or Syndrome (T047)
MSH D016862
ICD9 013.20, 013.2
SnomedCT 416265003, 40769007
English Intracranial Tuberculomas, Tuberculoma, Intracranial, Tuberculomas, Intracranial, Tuberculoma of brain, unspecified examination, intracranial tuberculoma, intracranial tuberculoma (diagnosis), Tuberculoma of brain (disorder), Tuberculoma of brain (finding), Intracranial Tuberculoma, Tuberculoma brain-unspec, Tuberculoma, Intracranial [Disease/Finding], Tuberculoma of brain, unspecified, brain of tuberculoma, tuberculoma of brain, brain tuberculoma, Tuberculoma of brain
Dutch hersentuberculoom, niet-gespecificeerd onderzoek, tuberculoom van de hersenen, Intracraniaal tuberculoom, Tuberculoom, intracraniaal
French Tuberculome du cerveau, Tuberculome du cerveau, examen non précisé, Tuberculome intracrânien
German Tuberkulom des Gehirns, Tuberkulom des Gehirns, unspezifische Untersuchung, Intrakranielles Tuberkulom, Tuberkulom, intrakranielles
Italian Tubercoloma dell'encefalo, Tubercoloma dell'encefalo, esame non specificato, Tubercoloma intracranico
Portuguese Tuberculoma cerebral com exame NE, Tuberculoma cerebral, Tuberculoma Intracraniano
Spanish Tuberculoma cerebral, Tuberculoma cerebral, estudio no especificado, tuberculoma del cerebro (trastorno), tuberculoma del cerebro, tuberculoma cerebral (trastorno), tuberculoma cerebral (hallazgo), tuberculoma cerebral, Tuberculoma Intracraneal
Japanese 脳結核腫、検査の詳細不明, 脳結核腫, ﾉｳｹｯｶｸｼｭ, ﾉｳｹｯｶｸｼｭｹﾝｻﾉｼｮｳｻｲﾌﾒｲ, 頭蓋内結核腫, 頭蓋内結核腫(ズガイナイケッカクシュ), 結核腫-頭蓋内, 結核腫-頭蓋内(ズガイナイ)
Swedish Tuberkulom, intrakraniellt
Czech tuberkulom intrakraniální, Tuberkulom mozku, Tuberkulom mozku, blíže neurčené vyšetření
Finnish Kallonsisäinen tuberkulooma
Russian VNUTRICHEREPNAIA TUBERKULEMA, TUBERKULEMA VNUTRICHEREPNAIA, ВНУТРИЧЕРЕПНАЯ ТУБЕРКУЛЕМА, ТУБЕРКУЛЕМА ВНУТРИЧЕРЕПНАЯ
Polish Gruźliczak wewnątrzczaszkowy
Hungarian Agyi tuberculoma, nem meghatározott vizsgálat, Agyi tuberculoma
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Tuberculosis, Central Nervous System (C0275904)

Definition (MSH) Tuberculosis of the brain, spinal cord, or meninges (TUBERCULOSIS, MENINGEAL), most often caused by MYCOBACTERIUM TUBERCULOSIS and rarely by MYCOBACTERIUM BOVIS. The infection may be limited to the nervous system or coexist in other organs (e.g., TUBERCULOSIS, PULMONARY). The organism tends to seed the meninges causing a diffuse meningitis and leads to the formation of TUBERCULOMA, which may occur within the brain, spinal cord, or perimeningeal spaces. Tuberculous involvement of the vertebral column (TUBERCULOSIS, SPINAL) may result in nerve root or spinal cord compression. (From Adams et al., Principles of Neurology, 6th ed, pp717-20)
Concepts Disease or Syndrome (T047)
MSH D020306
ICD9 013.90, 013.9
SnomedCT 186224007, 10706006
English Unspecified tuberculosis of central nervous system, Tuberculosis of central nervous system, NOS, Tuberculosis of CNS NOS, Tuberculosis of central nervous system NOS, Unspecified tuberculosis of central nervous system, unspecified examination, TUBERCULOSIS CNS, central nervous system tuberculosis (diagnosis), central nervous system tuberculosis, CNS tuberculosis, CNS TUBERCULOSIS, Central Nervous System Tuberculosis, Tuberculosis, Central Nervous System, Cns TB NOS-unspec, Tuberculosis of central nervous system NOS (disorder), Tuberculosis, Central Nervous System [Disease/Finding], Unspecified tuberculosis of central nervous system, unspecified, cns tuberculosis, Tuberculosis of central nervous system, Tuberculosis of central nervous system (disorder)
Dutch centraal zenuwstelseltuberculose NAO, niet-gespecificeerde tuberculose van het centraal zenuwstelsel, niet-gespecificeerd onderzoek, niet-gespecificeerde tuberculose van het centraal zenuwstelsel, centraal zenuwstelseltuberculose, Centrale zenuwstelsel, tuberculose van het, Tuberculose van het centrale zenuwstelsel, Zenuwstelsel, tuberculose van het centrale
French Tuberculose du système nerveux central SAI, Tuberculose non précisée du système nerveux central, examen non précisé, Tuberculose non précisée du système nerveux central, Tuberculose du système nerveux central, Tuberculose du SNC
German unspezifische Tuberkulose des Zentralnervensystems, unspezifische Untersuchung, unspezifische Tuberkulose des Zentralnervensystems, Tuberkulose des Zentralnervensystems NNB, Tuberkulose des Zentralnervensystems, Tuberkulose, Zentralnervensystem
Italian Tubercolosi del sistema nervoso centrale NAS, Tubercolosi non specificata del sistema nervoso centrale, Tubercolosi non specificata del sistema nervoso centrale, esame non specificato, Tubercolosi del sistema nervoso centrale
Portuguese Tuberculose do sistema nervoso central NE, Tuberculose NE do SNC, exame NE, Tuberculose NE do SNC, Tuberculose do sistema nervoso central, Tuberculose do Sistema Nervoso Central
Spanish Tuberculosis no especificada del sistema nervioso central, estudio no especificado, Tuberculosis no especificada del sistema nervioso central, Tuberculosis del sistema nervioso central NEOM, tuberculosis del SNC, tuberculosis del sistema nervioso central (trastorno), tuberculosis del sistema nervioso central, SAI (trastorno), tuberculosis del sistema nervioso central, SAI, tuberculosis del sistema nervioso central, Tuberculosis del sistema nervioso central, Tuberculosis del Sistema Nervioso Central
Japanese 中枢神経系結核ＮＯＳ, 詳細不明の中枢神経系結核、検査の詳細不明, 詳細不明の中枢神経系結核, ﾁｭｳｽｳｼﾝｹｲｹｲｹｯｶｸNOS, ｼｮｳｻｲﾌﾒｲﾉﾁｭｳｽｳｼﾝｹｲｹｲｹｯｶｸｹﾝｻﾉｼｮｳｻｲﾌﾒｲ, ﾁｭｳｽｳｼﾝｹｲｹｲｹｯｶｸ, ｼｮｳｻｲﾌﾒｲﾉﾁｭｳｽｳｼﾝｹｲｹｲｹｯｶｸ, 結核-中枢神経系, 中枢神経系結核
Swedish Tuberkulos, centrala nervsystemet
Czech tuberkulóza centrálního nervového systému, Blíže neurčená tuberkulóza centrálního nervového systému, blíže neurčené vyšetření, Tuberkulóza centrální nervové soustavy, Blíže neurčená tuberkulóza centrálního nervového systému, Tuberkulóza centrálního nervového systému NOS
Finnish Keskushermoston tuberkuloosi
Russian TUBERKULEZ TSENTRAL'NOI NERVNOI SISTEMY, ТУБЕРКУЛЕЗ ЦЕНТРАЛЬНОЙ НЕРВНОЙ СИСТЕМЫ
Croatian Not Translated[Tuberculosis, Central Nervous System]
Polish Gruźlica OUN, Gruźlica ośrodkowego układu nerwowego
Hungarian nem meghatározott központi idegrendszeri tuberculosis, Nem meghatározott központi idegrendszeri tuberculosis, nem meghatározott vizsgálat, központi idegrendszeri tuberculosis, központi idegrendszeri tuberculosis k.m.n.
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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