Study of Central Nervous System Tuberculosis.

Aims and Objective: To assess the clinical features, complications and outcome in patients with central nervous system tuberculosis (CNS TB) and to correlate the clinical, laboratory and radiological findings of CNS TB.

Materials and Methods: In a cross sectional study, total 50 diagnosed cases of CNS TB (either TB meningitis or tuberculoma) were studied. The data on demographic factors, clinical features, complications and laboratory findings, details of treatment and outcome were recorded and analyzed. Follow up was done during hospital stay and at the end of six months after completion of chemotherapy.

Results: Out of 50, 42 patients had TBM (tuberculous meningitis) and 8 patients had tuberculoma. Mean age of patients was 33.5 yrs with male preponderance (M: F = 6.2:1), 66% patients had duration of symptoms more than 4 weeks. Common symptoms were fever (100%), headache (70%) and vomiting (64%). CSF staining for AFB was positive in 8% patients, mean CSF protein was 157 mg%, 32 patients had CSF lymphocytosis, (count >90%), CSF PCR was positive in 92.85%, CSF ADA levels were high (> 10 U/L) in 90.47%. On neuroimaging, 62 % patients had meningeal enhancement and 8 patients had tuberculomas. 10 patients were in stage I of disease, 24 in stage II and 16 in stage III. 30% mortality was observed, more in HIV positive patients with stage III disease. On followed up after 6 months of discharged patients (n=35), 10 patients had full recovery and 17 had recovery with neurological deficit, however 8 patients lost follow up.

Conclusion: Diagnosis of CNS TB should be based on clinical features and 3 or more supportive criteria rather than CSF positivity on staining or culture. Rapid and early diagnosis by positive CSF PCR and CT/MRI findings should replace CSF AFB staining and culture in further for the diagnosis of CNS TB.