Meningeal tuberculosis is one of the most common presentations of TB among older people in the US who had been exposed to TB earlier in their lives.
When a reactivation of the TB takes place there is a high fever coupled with an severe headache. If not diagnosed, the symptoms will very quickly progress to drowsiness and coma. One of the complications can be thrombosis of one of the major blood vessels in the brain, which would mimic a stroke and TIA (transient ischemic attack). The neurologist can do a diagnostic lumbar puncture. This would show a glucose content of less than 50% of the serum glucose level, protein elevation and lymphocytic cells in the cerebrospinal fluid (CSF).
A commercial test using polymerase chain reaction to TB exists, which will be positive on this CSF sample. This test is rapid and specific for TB.
Anti-TB therapy using a multidrug combination chemotherapy as mentioned above can lead to a complete cure, provided the diagnosis was made early enough. Occasionally a brain abscess (thanks to www.scielo.br for this image) is found in the work-up of meningeal TB, in this case in an AIDS patient.
A neurosurgeon should then be consulted to decide whether or not this should be removed while the patient is covered with antituberculous drug therapy. These cases and meningeal TB are more frequent among AIDS patients. There are also more TB brain abscess cases among IV drug users in recent years.
1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 161.
2. TC Dixon et al. N Engl J Med 1999 Sep 9;341(11):815-826.
3. F Charatan BMJ 2000 Oct 21;321(7267):980.
4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 43.
5. JR Zunt and CM Marra Neurol Clinics Vol.17, No.4,1999: 675-689.
6. The Merck Manual, Home edition: Tuberculosis (thanks to www.merckmanuals.com for this link)
7. LE Chapman : Antivir Ther 1999; 4(4): 211-19.
8. HW Cho: Vaccine 1999 Jun 4; 17(20-21): 2569-2575.
9. DO Freedman et al. Med Clinics N. Amer. Vol.83, No 4 (July 1999): 865-883.
10. SP Fisher-Hoch et al. J Virol 2000 Aug; 74(15): 6777-6783.
11. Mandell: Principles and Practice of Infectious Diseases, 5th ed., © 2000 Churchill Livingstone, Inc.
12. Goldman: Cecil Textbook of Medicine, 21st ed., Copyright © 2000 W. B. Saunders Company
13. PE Sax: Infect DisClinics of N America Vol.15, No 2 (June 2001): 433-455.
14. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
15. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier