Pulmonology Book

Tuberculosis

  • Central Nervous System Tuberculosis

http://www.fpnotebook.com/

Central Nervous System TuberculosisAka: 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

Tuberculoma, Intracranial (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.
ConceptsDisease or Syndrome (T047)
ICD9013.2, 013.3
MSHD016862
EnglishIntracranial Tuberculoma, Intracranial Tuberculomas, Tuberculoma of brain, Tuberculous abscess of brain, Tuberculous intracranial abscess
Spanishabsceso cerebral tuberculoso, absceso intracraneal tuberculoso, absceso tuberculoso del cerebro, tuberculoma cerebral, tuberculoma del cerebro
Parent ConceptsTuberculosis of meninges and central nervous system (C0152654), Tuberculoma (C0041295), Tuberculosis, Central Nervous System (C0275904), Tuberculoma, Intracranial (C0085388), Tuberculosis of brain (C0275909), Intracranial non-pyogenic abscess (C0393499), Mass in head or neck (C0476250), Ambiguous concept (C1274012), Infective disorder of head (C1285329), Head finding (C1320354), Cerebral Abscess (C1510428)
SourcesICD9CM, MSH, NDFRT, SCTSPA, SNOMEDCT
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)
ConceptsDisease or Syndrome (T047)
ICD9013.9, 013.9, 013.90
MSHD020306
EnglishCentral Nervous System Tuberculosis, CNS TUBERCULOSIS, TUBERCULOSIS CNS, Tuberculosis of central nervous system, Unspecified tuberculosis of central nervous system
Spanishtuberculosis del sistema nervioso central, tuberculosis del SNC
Parent ConceptsTuberculosis of meninges and central nervous system (C0152654), Tuberculosis, Central Nervous System (C0275904), Tuberculosis (C0041296), Central Nervous System Bacterial Infections (C0752180), Mycobacterial infection of the central nervous system (C1320199)
SourcesICD9CM, MSH, MTHICD9, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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