3,060 results on '"CNS tuberculosis"'
Search Results
202. An unusual presentation of brain tuberculoma: A review of clinical features, radiographic and laboratory findings of CNS tuberculosis in adults
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Narges Najafi, Tayebi, A., Alikhani, A., and Davoudi, A.
203. Biological risk factor of occupational morbidity with tuberculosis among medical professionals
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medicine.medical_specialty ,Epidemiologic study ,Tuberculosis ,business.industry ,Urinary system ,General Medicine ,Drug resistance ,medicine.disease ,Disease cluster ,Respiratory tuberculosis ,Internal medicine ,CNS TUBERCULOSIS ,medicine ,Risk factor ,business - Abstract
The article presents molecular genetic characteristics of M. tuberculosis circulating in Omsk region, as a biologic risk factor of tuberculosis morbidity among medical institutions workers. The authors used descriptive method of epidemiologic study, method of MIRUVNTR-typing of M. tuberculosis DNA. Findings are M. tuberculosis stains of Beijing genotype with VNTR-profile 233325173533424, isolated out of tuberculosis patients cluster being under stationary treatment. 65.2% of the stains had multiple drug-resistance to anti-tuberculosis medications. Respiratory tuberculosis was diagnosed in 85.4% of the cases, extra-pulmonary tuberculosis (urinary system, peripheral lymph nodes, eyes, CNS tuberculosis) equaled 14.6%. Nearly 30% of tuberculosis cases in the health care workers were associated with the bacterioexcretion.
- Published
- 2018
204. A scoring system to effectively evaluate central nervous system tuberculosis in patients with military tuberculosis.
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Xiao, Yongjiu, Yu, Shuqing, Xue, Qingliang, Lang, Shan, Sun, Junping, Feng, Dan, and Wang, Jianxin
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TUBERCULOSIS treatment ,C-reactive protein ,SERUM albumin ,CENTRAL nervous system diseases ,LOGISTIC regression analysis - Abstract
There is currently no convenient way to effectively evaluate whether a miliary tuberculosis patient is complicated with central nervous system (CNS) tuberculosis. We aimed to find such a way by analyzing the clinical data of these patients. Fifty patients with confirmed miliary tuberculosis and 31 patients with confirmed miliary tuberculosis complicated with CNS tuberculosis from 2010 to 2014 were selected. Their general conditions, clinical features and laboratory tests were analyzed. Factors that were significantly different between them were chosen to performed multivariate and univariate logistic regression analyses, and factors with significant P values were used to establish a scoring system. Eight factors, i.e., age, cough, nausea, headache, hemoglobin (HGB), serum albumin (ALB), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were significantly different (P < 0.05). Multivariate logistic regression analysis showed that ALB was the independent risk predictor (HR = 1.29, 95% CI 1.09–1.52, P < 0.01), whereas the others were non-independent predictors except age (P < 0.05). The scoring system was based on a summation of the scores of the assigned values of the seven predictors and had an area under the curve (AUC) of 0.86 to confirm CNS tuberculosis, with a sensitivity of 81.5% and a specificity of 81.4% at a score of 0.75 and with a specificity of 95.3% at a score of 2.75. In contrast, a score below -0.75 excluded CNS tuberculosis, with a sensitivity of 88.9% and a specificity of 62.7%. The scoring system should be useful to evaluate whether a miliary tuberculosis patient is complicated with CNS tuberculosis and could help doctors avoid excessive investigation. [ABSTRACT FROM AUTHOR]
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- 2017
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205. Meningoencefalite tuberculosa: avaliação de 231 casos Tuberculosis meningoencephalitis: exposure of 231 cases
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Ceuci Nunes, Sérgio Cunha, Nilton Gomes, Adelci Tavares, Dilcinéia Amorim, Irênio Gomes, and Ailton Melo
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Meningoencefalite tuberculosa ,Meningite tuberculosa ,Tuberculose do SNC ,Tuberculose ,Tuberculous meningoencephalitis ,Tuberculous meningitis ,CNS tuberculosis ,Tuberculosis ,Arctic medicine. Tropical medicine ,RC955-962 - Abstract
Neste estudo foram avaliados 231 pacientes com meningoencefalite tuberculosa, sendo que 62 casos tiveram diagnóstico comprovado e 169 apresentavam quadro clínico e laboratorial compatíveis com este diagnóstico. Foram 127 (55%) pacientes do sexo masculino, a idade variou de 1 mês a 68 anos, com 97 (42%) na faixa etária igual ou inferior a um ano. As características clínicas, demográficas e liquóricas foram estudadas e comparadas entre os casos confirmados e os de diagnóstico provável. Em conclusão reafirmamos a gravidade desta doença, com altas taxas de letalidade principalmente na faixa etária de zero a quatro anos e a possibilidade de erros diagnósticos nas apresentações com formas agudas e predominância de neutrófilos no líquor.This study assessed 231 cases of tuberculous meningitis of which 62 (26.8%) had diagnostic confirmation against 169 (73.2%) with only clinical picture and laboratorial indication for this diagnosis. Fifty-five percent of the sample was male; ages ranged from one month to 68 years, 42% comprising children below four years.Clinical, demographic and liquoric characteristics were investigated and compared amongst those with likely and confirmed diagnosis. In conclusion, atention is drawn to the severity of this desease with high rates of lethality mainly within the age-range of 0-4 years, and to the possibility of misdiagnosis in the presentation of acute forms and predominance of neutrophils in the liquor.
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- 1998
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206. Rapid diagnosis of CNS tuberculosis by a t-cell interferon-gamma release assay on cerebrospinal fluid mononuclear cells.
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Kösters K, Nau R, Bossink A, Greiffendorf I, Jentsch M, Ernst M, Thijsen S, Hinks T, Lalvani A, and Lange C
- Abstract
Central nervous system tuberculosis remains a clinical diagnostic challenge. The ex vivo Mycobacterium tuberculosis-specific enzyme-linked immunospot assay (ELISPOT) is a novel assay for the rapid detection of M. tuberculosis-specific T-lymphocytes in the peripheral blood. However, when performed on peripheral blood, this assay cannot distinguish between active tuberculosis or latent tuberculosis infection. On the assumption that M. tuberculosis-specific T-lymphocytes migrate to sites of infection, we were able to demonstrate high levels of M. tuberculosis-specific cells by ELISPOT in the cerebrospinal fluid of a patient with tuberculous meningitis and intracerebral tuberculoma four weeks before cerebrospinal fluid culture became positive for M. tuberculosis by culture. [ABSTRACT FROM AUTHOR]
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- 2008
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207. Neuroimaging Changes and Treatment Outcome of Tubercular Meningitis-Experiences 22 Cases in a Tertiary Care Center.
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KUNDU, G. K., ZAHAN, G. A., SARKER, M. A., and DOLA, F. N.
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TUBERCULOUS meningitis ,SYMPTOMS ,TREATMENT effectiveness ,PEDIATRIC neurology ,TERTIARY care ,MYCOBACTERIUM tuberculosis - Abstract
Background: Tuberculous meningitis (TBM) is caused by Mycobacterium tuberculosis (M. tuberculosis) and is the most common form of central nervous system (CNS) tuberculosis (TB). The prevalence of TB meningitis remains largely underestimated because clinical manifestations are nonspecific in early stages of the disease. Prompt diagnosis is critical for initiating appropriate therapy, facilitating measures to prevent dissemination of this highly contagious disease and to combat fatal complication in children Aims: To evaluate the role of neuroimaging changes and treatment outcome of tubercular meningitis. Methods: This prospective hospital-based cohort study was conducted in Department of Paediatric Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, during January 2022 to December 2022. Children age belonged to 1 month to 10 year diagnosed as TBM during study period were enrolled in this study. Detailed history, clinical examination, CSF analysis and other relevant investigations were done. Data were recorded in standard questionnaire. Statistical analyses of the results were obtained by using windowbased computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: Total 22 diagnosed case of TBM was enrolled and evaluated. Among them two third (63.63%) children were in 5-10 year age group. Male (59%) were outnumbered than female (36.36 %). Male female ratio was 1.6:1. More than half (59%) of patients came from urban area. All of the patients were vaccinated. Cent percent (100%) patients were presented with fever followed by headache (77.27%), sign of meningeal irritation (54.54%), vomiting (54.54%) and seizures (50%). Most common complication was hemiparesis (45.45%) followed by cranial nerve palsy (40.90%), visual problem (9.09%) and hydrocephalus (4.54%). Abnormal neuroimaging changes were found in 100% cases. Common findings were hydrocephalus (40.90%), tubercloma (36.36%), basilar enhancement (18.18%), Benign enlargement of subdural space & cerebellar hyperintensity (9%) and thalamic infract was present in 4.54% cases. Anti TB and steroid treatment were given in 100% cases and among them18.18% cases were required shunt procedure. More than one-third cases (40.90%) were completely normal without any no sequelae. Among abnormal sequelae found in two third (59%) cases. Speech impairment (36.36%) was most common followed by GDD (18.18%), hemiparesis (13.63%), quadriparesis (9.09%) and epilepsy in 9.09% cases. Conclusion: In our study all children of TBM were presented with fever followed by other predominant clinical features headache, vomiting, seizures and sign of meningeal irritation. Abnormal neuroimaging changes were found in all cases. Common findings were basilar enhancement, hydrocephalus, tubercloma, benign enlargement of subdural space & cerebellar hyper intensity and thalamic infract. After treatment more than one-third cases were completely normal without any no sequelae. [ABSTRACT FROM AUTHOR]
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- 2024
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208. NEUROSURGICAL CARE FOR HIV-INFECTED PATIENTS WITH LOCAL FORMS OF TUBERCULOSIS OF CENTRAL NERVOUS SYSTEM
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O. N. Novitskaya, S. I. Petrov, and O. V. Kanya
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hiv infection ,medicine.medical_specialty ,Tuberculosis ,cerebral tuberculous abscess ,medicine.diagnostic_test ,RC705-779 ,business.industry ,General Medicine ,medicine.disease ,central nervous system ,Surgery ,Conservative treatment ,Lesion ,Diseases of the respiratory system ,Sensitivity testing ,CNS TUBERCULOSIS ,Biopsy ,medicine ,Perifocal edema ,biopsy ,medicine.symptom ,drug sensitivity ,business - Abstract
Goal of the study: to define the interaction procedure between phthisiologists and neurosurgeons when managing local tuberculosis of central nervous system in HIV-infected patients. Materials and methods. Histological, mycobacteriologic and X-ray features of CNS tuberculosis were studied in 73 died and 5 operated HIV-infected patients. Results. Stepwise treatment of the patients with local HIV-associated tuberculous lesions of brain includes conservative treatment with the search for the causative agent in all available biological liquids, and should the therapy fail then the decision is made about biopsy for diagnosis confirmation and sensitivity testing and the consequent decision about surgery aimed to remove the lesion. The surgery can be performed only after the relevant anti-bacterial treatment in compliance with drug sensitivity data till perifocal edema is not visible on the brain images.
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- 2016
209. Fatal central nervous system co-infection with SARS-CoV-2 and tuberculosis in a healthy child
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Nidal El-Wiher, Graham Krasan, Mitual Amin, Bishara J Freij, Rabail Tariq, Ay-Ming Wang, Bassam M Gebara, Kelly Levasseur, Joseph M Fullmer, Paul M Patek, and John P. Gibson
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DNA, Bacterial ,0301 basic medicine ,medicine.medical_specialty ,Tuberculosis ,Pneumonia, Viral ,Pediatric infections ,Mycobacterium tuberculosis ,Betacoronavirus ,03 medical and health sciences ,Fatal Outcome ,0302 clinical medicine ,Meningoencephalitis ,Biopsy ,Case report ,medicine ,Humans ,030212 general & internal medicine ,Seroconversion ,Pandemics ,CNS tuberculosis ,biology ,medicine.diagnostic_test ,Coinfection ,business.industry ,SARS-CoV-2 ,lcsh:RJ1-570 ,COVID-19 ,lcsh:Pediatrics ,Tuberculosis, Central Nervous System ,biology.organism_classification ,medicine.disease ,Pneumonia ,030104 developmental biology ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Immunology ,RNA, Viral ,Female ,Histopathology ,Coronavirus Infections ,business - Abstract
Background Central and peripheral nervous system symptoms and complications are being increasingly recognized among individuals with pandemic SARS-CoV-2 infections, but actual detection of the virus or its RNA in the central nervous system has rarely been sought or demonstrated. Severe or fatal illnesses are attributed to SARS-CoV-2, generally without attempting to evaluate for alternative causes or co-pathogens. Case presentation A five-year-old girl with fever and headache was diagnosed with acute SARS-CoV-2-associated meningoencephalitis based on the detection of its RNA on a nasopharyngeal swab, cerebrospinal fluid analysis, and magnetic resonance imaging findings. Serial serologic tests for SARS-CoV-2 IgG and IgA showed seroconversion, consistent with an acute infection. Mental status and brain imaging findings gradually worsened despite antiviral therapy and intravenous dexamethasone. Decompressive suboccipital craniectomy for brain herniation with cerebellar biopsy on day 30 of illness, shortly before death, revealed SARS-CoV-2 RNA in cerebellar tissue using the Centers for Disease Control and Prevention 2019-nCoV Real-Time Reverse Transcriptase-PCR Diagnostic Panel. On histopathology, necrotizing granulomas with numerous acid-fast bacilli were visualized, and Mycobacterium tuberculosis complex DNA was detected by PCR. Ventricular cerebrospinal fluid that day was negative for mycobacterial DNA. Tracheal aspirate samples for mycobacterial DNA and culture from days 22 and 27 of illness were negative by PCR but grew Mycobacterium tuberculosis after 8 weeks, long after the child’s passing. She had no known exposures to tuberculosis and no chest radiographic findings to suggest it. All 6 family members had normal chest radiographs and negative interferon-γ release assay results. The source of her tuberculous infection was not identified, and further investigations by the local health department were not possible because of the State of Michigan-mandated lockdown for control of SARS-CoV-2 spread. Conclusion The detection of SARS-CoV-2 RNA in cerebellar tissue and the demonstration of seroconversion in IgG and IgA assays was consistent with acute SARS-CoV-2 infection of the central nervous infection. However, the cause of death was brain herniation from her rapidly progressive central nervous system tuberculosis. SARS-CoV-2 may mask or worsen occult tuberculous infection with severe or fatal consequences.
- Published
- 2020
210. Role of PET-CT in Central Nervous System Tuberculosis
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Kasturi Rangan, Sanjay Gambhir, and Manish Ora
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medicine.medical_specialty ,PET-CT ,Tuberculosis ,business.industry ,Mortality rate ,Central nervous system ,Disease ,medicine.disease ,Therapy response ,medicine.anatomical_structure ,Radiological weapon ,CNS TUBERCULOSIS ,medicine ,Intensive care medicine ,business - Abstract
Central nervous system tuberculosis (CNS TB) is an important disease with very high mortality rate. Accurate diagnosis and appropriate treatment for this disease are upmost priority to reduce the mortality rate. Diagnosis of CNS TB has been done by various clinical and radiological investigations, and 18F FDG PET-CT is the new tool in the diagnostic armamentarium. In this book chapter, we try to explore all the possible CNS manifestation of the CNS TB, try to touch upon the HIV-related CNS TB, therapy response to anti-tubercular drugs and few quantitative analyses by software methods.
- Published
- 2020
211. A rare case of tuberculoma masquerading as CP Angle neoplasm
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Kaushik Roy, Sinjan Ghosh, Sourav Nanda, Nikhil Repaka, Annesh Bhattacharjee, Niraja Agasti, and Gautam Guha
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medicine.medical_specialty ,business.industry ,tuberculoma ,cp angle sol ,lcsh:R ,lcsh:Medicine ,medicine.disease ,Cerebellopontine angle ,Rare case ,medicine ,Neoplasm ,Tuberculoma ,tuberculosis radiology ,Radiology ,General Agricultural and Biological Sciences ,business ,cns tuberculosis - Abstract
Tuberculoma involving the cerebellopontine angle is very rare. Preoperative neuroradiological features of such lesions may mimic neoplastic lesions. Our case presented with cerebellar features and multiple cranial nerve palsy. Neuroimaging mimicked CP angle neoplastic lesion. Antitubercular therapy and steroids resulted in significant clinical improvement and marked radiological reduction in size of the lesion. In our subcontinent a treatable infective cause like tuberculosis should be ruled out in CP angle lesions. Although rare but definitely a possibility to be considered.
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- 2019
212. Guidelines versus ground lines: Tuberculosis of the central nervous system.
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Khadilkar, Satish, Kadam, Nikhil, Kulkarni, Rahul, Meshram, Chandrashekhar, Meshram, Archana, Patel, Bhagyadhan, Chheda, Akash, Khadilkar, Satish V, Kadam, Nikhil D, Kulkarni, Rahul V, Meshram, Chandrashekhar M, Meshram, Archana R, Patel, Bhagyadhan A, and Chheda, Akash H
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CENTRAL nervous system , *TUBERCULOSIS , *ANTITUBERCULAR agents , *ADENOSINE deaminase , *POLYMERASE chain reaction - Abstract
Aim: This questionnaire-based national survey is aimed at understanding the patterns of practice of various aspects of central nervous system (CNS) tuberculosis (TB) among neurologists.Settings and Design: Neurology department of a tertiary medical college.Materials and Methods: A questionnaire was sent through email to all practicing neurologists in India. The responses were analyzed.Statistical Analysis: Inferential statistics.Results: In all, 144 responses were received (out of the 853 questionnaires sent). The major discrepancies were in the primary antitubercular drug regimen (HRZE + HR), duration for tubercular meningitis (TBM) [12 months] and tuberculoma (12-18 months) to develop, follow-up (varied), linezolid use (varied), proportion of drug-resistant cases (<25%), and not taking histological aids (91%). The cerebrospinal fluid (CSF) TB polymerase chain reaction (PCR) utility (75%), not using CSF adenosine deaminase [ADA] (58%), the strategy to stop antitubercular drugs, and the use of steroids (77%) were according to guidelines.Conclusion: The present survey, for the first time, provides ground-level evidence of various aspects of CNS TB as practiced by neurologists in India. The major diversity was observed in therapeutics such as the choice of antitubercular drugs, its duration, linezolid use beyond the recommended duration, and knowledge of drug resistance. The monitoring aspects of CNS TB also showed variations. The investigational aspects of CNS TB such as using TB PCR, not using CSF ADA, and regular neuroimaging revealed a good clinical practice. Other CSF parameters require uniformity. This survey thus helps to identify areas of future work in CNS TB in India. [ABSTRACT FROM AUTHOR]- Published
- 2019
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213. Tuberculome cérébral un challenge diagnostic: à propos d'un cas et mise au point.
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Koffi, Patrice Niamien, Ouambi, Olivier, El Fatemi, Nizar, and El Maaquili, Rachid
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Central nervous system (CNS) tuberculosis is the second most common presentation after tuberculous meningitis. It is a major cause of morbidity and mortality in the developing countries, accounting for 10-30% of intracranial expansive lesions in these countries against 0.2% in some Western countries. This study aims to report an atypical clinical and radiological manifestation (brain MRI and spectroscopy) of cerebral tuberculoma in order to provide an update on this infectious disease. The study involved a 44-year old female patient with no particular previous history, with headaches persisting for 1 year and complicated by partial secondarily generalized seizures and heaviness at the left hemicorpus with episodes of vomiting without visual disorder or fever or deterioration of general condition after 8 months. Clinical examination showed conscious patient with Glasgow Coma Scale (GCS) 15, equal and reactive pupils, walking and/or standing without fault, with 4/5 left-sided hemiparesis without other neurological signs. Brain MRI objectified right parietal subtentorial plurilobulated isointense poorly differentiated lesion on T1 weighted sequence without contrast agents injection and heterogeneous lesion with hyperintense edge and hypointense fundus, suggesting fleshy process with areas of central necrosis and perilesionnal edema extending in finger-like fashion with intense annular enhancement after gadolinium injection on T2 weighted sequence. Spectroscopy showed glial tumor. The patient received anticonvulsant therapy and macroscopic complete resection. Anatomopathologic analysis showed cerebral tuberculoma. She received antituberculosis drugs with seizure stoppage and deficit recovery after 4 weeks. This study highlights the clinical and radiological polymorphism of cerebral tuberculoma. This is suspected based on laboratory tests as well as on a body of clinical and radiological evidences but definitive diagnosis is based on anatomopathologic analysis. Early management is essential because complications can be severe and result in a poor prognosis. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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214. Successful rapid oral desensitization for dual hypersensitivity to isoniazid and rifampin while treating central nervous system tuberculosis.
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Roy, Moni, Ahmad, Sharjeel, and Roy, Ashish Kumar
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CENTRAL nervous system , *INFECTION , *TUBERCULOSIS , *ALLERGIES ,CENTRAL nervous system infections - Abstract
Tuberculosis of the central nervous system (CNS-TB) is a critical disease with poor prognosis if not diagnosed and treated early. A regimen of drugs with good CNS penetration is required for treatment. Treatment options are limited in case of hypersensitivity reaction of the recommended regimen. We are reporting a rare instance where a patient developed hypersensitivity to both first line agents (isoniazid and rifampin) for CNS-TB and was successfully desensitized against both these medications to complete the treatment course using the rapid desensitization process. There have been reported cases of desensitization to anti tuberculous medications in cases with pulmonary tuberculosis and hypersensitivity reaction. In this review article we discuss the prior used methods of slow and rapid desensitization in case on non-CNS tuberculosis infections. This is the first reported case to use similar method of rapid desensitization in treatment of central nervous system infection. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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215. Drug Resistance in Children with Central Nervous System Tuberculosis from a Tertiary Care Center in Mumbai.
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Mane, Sushant S, Janardhanan, Jyothi, Pustake, Manas, Ali, Mohammed Kashif, and Khan, Gazi Israil
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TUBERCULOSIS , *DRUG resistance , *TERTIARY care , *DAY care centers , *DEMOGRAPHIC characteristics , *PATIENT compliance , *TUBERCULOSIS epidemiology , *TUBERCULOSIS diagnosis , *DRUG therapy for tuberculosis , *SPECIALTY hospitals , *MYCOBACTERIUM tuberculosis , *ANTITUBERCULAR agents , *DRUG resistance in microorganisms , *MICROBIAL sensitivity tests , *PHARMACODYNAMICS - Abstract
Introduction: Central Nervous System tuberculosis (CNS-TB) is the most lethal form of extra-pulmonary TB, especially in children. In this study, we have discussed patterns of drug resistance in pediatric CNS-TB.Materials and Methods: Prospective observational study conducted on 100 children at a tertiary care center. Diagnosed cases of CNS-TB were enrolled. GeneXpert MTB/RIF was used upfront for diagnosis, and in cases where TB MGIT culture was positive, a phenotypic Drug Susceptibility Test (DST) was done. Patients were divided into resistant to at least one drug (DR) and drug-susceptible (DS). Various parameters were compared between these groups.Results: Mean age of participants was 5.84 ± 3.5 years, with a male-to-female ratio of 1.08 : 1; 14% of children had drug-resistant CNS TB (DR-CNS-TB). A higher proportion of children previously treated for TB were associated with drug resistance (p = 0.009), and those with disseminated TB also had a higher drug resistance (p = 0.002). Apart from this, the DR and DS groups had no statistically significant differences in demographic, clinical or epidemiological parameters.Conclusions: Previous history of being treated for TB and disseminated TB was an independent risk factor for DR-CNS-TB. Ensuring proper adherence and compliance to anti-tubercular treatment could help in preventing the emergence of DR TB. [ABSTRACT FROM AUTHOR]- Published
- 2021
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216. Tuberculome cérébral un challenge diagnostic: à propos d’un cas et mise au point
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Nizar El Fatemi, Patrice Niamien Koffi, Rachid El Maaquili, and Olivier Ouambi
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Cerebral tuberculoma ,medicine.medical_specialty ,spectroscopy ,brain MRI ,030231 tropical medicine ,Physical examination ,Case Report ,Tuberculous meningitis ,spectroscopie ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,IRM cérébrale ,central nervous system (CNS) tuberculosis ,medicine ,030212 general & internal medicine ,medicine.diagnostic_test ,business.industry ,Glasgow Coma Scale ,General Medicine ,tuberculose du système nerveux central ,medicine.disease ,Maroc ,Morocco ,Hemiparesis ,Vomiting ,Tuberculoma ,Radiology ,medicine.symptom ,Headaches ,Tuberculome cérébral ,business - Abstract
La tuberculose du système nerveux central est le deuxième site le plus fréquent après la méningite tuberculeuse. Elle est une cause majeure de morbidité et de mortalité dans les pays en développement et représente 10 à 30% des lésions expansives intracrâniennes dans ces pays contre 0,2% dans certains pays occidentaux. Le but de cet article est de présenter un cas atypique de tuberculome cérébral dans sa présentation clinique et radiologique (l'IRM cérébrale et de la spectroscopie), de faire une mise au point à partir de cette observation sur cette pathologie infectieuse. Il s'agit d'une patiente de 44 ans, sans antécédent médico-chirurgical, qui a présenté depuis un an des céphalées, compliquées 08 mois après de crises d'épilepsies partielles à généralisation secondaire et de lourdeur de l'hémicorps gauche avec des épisodes de vomissements sans trouble visuel ni fièvre ni altération de l'état général. L'examen clinique trouvait une patiente consciente GCS= 15, pupilles égales et réactives, station debout et marche possible sans anomalie, avec hémiparésie gauche 4/5 sans autres signes neurologiques. L'IRM cérébrale objectivait en séquence T1 non injectée une lésion pariétale droite sus tentoriel plurilobées iso intense mal limitée, en séquence T2 elle est hétérogène avec un liseré hyper intense et un fond hypo intense traduisant un processus charnu avec des zones de nécroses centrales et un œdème péri-lésionnel en doigt de gans en séquence FLAIR, avec une prise de contraste annulaire intense après injection de gadolinium. L'analyse de la spectroscopie était en faveur d'une tumeur gliale. La patiente fut mise sous anticonvulsivant et a bénéficié d'un abord direct avec exérèse macroscopiquement complète. L'analyse anatomopathologique était en faveur d'un tuberculome cérébral. Elle a été mise sous traitement antituberculeux avec arrêt des crises et récupération du déficit après 04 semaines. A travers ce cas nous entrevoyons le polymorphisme clinique et radiologique qu'est le tuberculome cérébral. Il est évoqué devant un faisceau d'argument clinique, biologique et radiologique mais le diagnostic de certitude reste essentiellement anatomopathologique. La prise en charge ne saurait tarder car les complications sont néfastes et de mauvais pronostic lorsqu'il est détecté tardivement.
- Published
- 2019
217. Symptomatic central nervous system tuberculosis and human herpesvirus-6 coinfection with associated hydrocephalus managed with endoscopic third ventriculostomy: A case report and review of human herpesvirus-6 neuropathology.
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Bui, Nicholas Edward, Savla, Paras, Galvis, Alvaro E., and Hanak, Brian William
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HUMAN herpesvirus-6 ,INFECTION ,MAGNETIC resonance imaging ,CENTRAL nervous system ,GLASGOW Coma Scale - Abstract
Background: Human herpesvirus 6 (HHV-6) is a double-stranded DNA virus well established in the clinical literature to cause the near-universal childhood infection roseola infantum (exanthema subitum/sixth disease). Primary HHV-6 infection has been reported to cause meningoencephalitis in pediatric patients, although generally in the immunocompromised. Case Description: The authors treated an immunocompetent 18-month-old female who transferred to our institution for a higher level of care given concerns for meningitis in the setting of decreased level of arousal (Glasgow Coma Scale 12), and bradycardia 9 days after the onset of nasal congestion, fatigue, and repeated bouts of emesis. Outside hospital cerebrospinal fluid (CSF) studies were notable for hypoglycorrhachia, elevated protein, elevated nucleated cells with a mononuclear predominance, and a meningitis polymerase chain reaction panel that was positive only for HHV-6. Brain magnetic resonance imaging with and without contrast revealed a basal cistern predominant leptomeningeal enhancement pattern as well as moderate ventriculomegaly with associated periventricular edema concerning acute communicating hydrocephalus. Considering the CSF studies, neuroimaging, and recent travel history to Mexico, central nervous system (CNS) tuberculosis (TB) was the leading suspicion, and antimicrobial therapy was initiated for this presumptive diagnosis with culture data only proving the TB suspicion correct after nearly 2 months in culture. Anti-viral therapy was initially not felt to be necessary as the HHV-6 was interpreted as incidental and not a cause of symptomatic meningitis in our immunocompetent host. The patient's hydrocephalus was treated with temporary CSF diversion followed by performance of an endoscopic third ventriculostomy. Despite appropriate hydrocephalus management, clinical improvement ultimately seemed to correlate with the initiation of antiviral therapy. Conclusion: The authors present this case and review the literature on HHV-6-associated CNS infections with the goal of informing the neurosurgeon about this often clinically underestimated pathogen. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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218. Non‐osseous intradural tuberculoma of the thoracic spine with compressive myelopathy.
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Duvuru, Shyam, Sanker, Vivek, Naureen, Syed, Prakash, Gupta, Sanjana, Rajurkar, and Dave, Tirth
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TUBERCULOMA ,THORACIC vertebrae ,SPINAL tuberculosis ,SPINAL cord compression ,SPINAL cord tumors ,PATIENT experience - Abstract
Key Clinical Message: An uncommon form of CNS tuberculosis called non‐osseous IDEM tuberculoma frequently results from paradoxical drug interactions. It should be considered one of the differentials when patients receiving ATT experience acute neurological impairment. Tuberculoma affecting the spinal cord is a rare condition in modern times. The occurrence of non‐osseous intradural tuberculosis, specifically in the spine, is even more exceptional. In fact, it is uncommon to encounter an intradural extramedullary tuberculous granuloma that lacks radiological indications of vertebral involvement, especially within the thoracic region. We present a case of a patient with a neurological deficit caused by a non‐osseous intradural tuberculoma in the thoracic region, without any associated bone involvement. The patient experienced a gradual deterioration of neurological function. An MRI of the thoracic spine revealed the presence of a tuberculoma located intradurally, extramedullary, and juxtamedullary of the T5 vertebra. The compression of the spinal cord resulted in paraparesis which was worsening to paraplegia. A D4–D6 laminectomy and microsurgical excision were performed under intraoperative neurophysiological monitoring (IONM), and the patient showed clinical recovery. Excellent clinical outcomes were achieved. However, it is crucial to consider the possibility of a non‐osseous intradural tuberculoma as a rare condition when encountering a SOL, particularly in patients with a history of tuberculosis and spinal cord compression. In cases where a progressing neurological deficit is present, a combination of surgical intervention and anti‐tuberculous treatment should be considered as the optimal approach. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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219. Central Nervous System Tuberculosis
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Deepak Patkar, Jayant Narang, Rama Yanamandala, Malini A. Lawande, and Gaurang Shah
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medicine.medical_specialty ,Pathology ,Tuberculosis ,medicine.diagnostic_test ,business.industry ,Central nervous system ,Magnetic resonance imaging ,General Medicine ,Disease ,medicine.disease ,Pathophysiology ,medicine.anatomical_structure ,Pandemic ,CNS TUBERCULOSIS ,medicine ,Radiology, Nuclear Medicine and imaging ,Tuberculoma ,Neurology (clinical) ,Intensive care medicine ,business - Abstract
With the onset of the human immunodeficiency virus pandemic, the incidence of tuberculosis, including central nervous system (CNS) tuberculosis, has increased in developed countries. It is no longer a disease confined to underdeveloped and developing countries. The imaging appearance has become more complex with the onset of multidrug-resistant tuberculosis. Imaging plays an important role in the early diagnosis of CNS tuberculosis and may prevent unnecessary morbidity and mortality. This article presents an extensive review of typical and atypical imaging appearances of intracranial tuberculosis, and discusses pathogenesis, patterns of involvement, and advances in imaging of intracranial tuberculosis.
- Published
- 2012
220. Metagenomic next-generation sequencing for identification of central nervous system pathogens in HIV-infected patients.
- Author
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Yunqi Zhu, Wenxuan Zhao, Xihong Yang, Yuanyuan Zhang, Xiaoling Lin, Xing Weng, Yali Wang, Cong Cheng, Yun Chi, Hongxia Wei, Zhihang Peng, and Zhiliang Hu
- Subjects
CENTRAL nervous system ,EPSTEIN-Barr virus ,NUCLEOTIDE sequencing ,JOHN Cunningham virus ,MYCOBACTERIUM tuberculosis ,TORQUE teno virus ,METAGENOMICS - Abstract
Although considerable interest in metagenomic next-generation sequencing (mNGS) has been attracted in recent years, limited data are available regarding the performance of mNGS in HIV-associated central nervous system (CNS) infection. Here, we conducted a retrospectively analyzing of the cerebrospinal fluid (CSF) mNGS reports and other clinical data from 80 HIV-infected patients admitted to the Second Hospital of Nanjing, China from March, 2018 to March, 2022. In our study, CSF mNGS reported negative result, mono-infection, and mixed infection in 8.8, 36.2, and 55% of the patients, respectively. Epstein-Barr virus (EBV), positive in 52.5% of samples, was the most commonly reported pathogen, followed by cytomegalovirus (CMV), John Cunningham virus (JCV), torque teno virus (TTV), cryptococcus neoformans (CN), toxoplasma Gondii (TE), and mycobacterium tuberculosis (MTB). 76.2% of the EBV identification and 54.2% of the CMV identification were not considered clinically important, and relative less sequence reads were reported in the clinical unimportant identifications. The clinical importance of the presence of TTV in CSF was not clear. Detection of JCV, CN, or TE was 100% suggestive of specific CNS infection, however, 60% of the MTB reports were considered contamination. Moreover, of the 44 (55%) mixed infections reported by mNGS, only 4 (5%) were considered clinical important, and mNGS failed to identify one mixed infection. Additionally, except for MTB, CSF mNGS tended to have high sensitivity to identify the above-mentioned pathogens (almost with 100% sensitivity). Even all the diagnostic strategies were evaluated, the cause of neurological symptoms remained undetermined in 6 (7.5%) patients. Overall, our results suggest that mNGS is a very sensitive tool for detecting common opportunistic CNS pathogen in HIV-infected patients, although its performance in CNS tuberculosis is unsatisfactory. EBV and CMV are commonly detected by CSF mNGS, however, the threshold of a clinical important detection remains to be defined. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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221. The etiological spectrum of miliary brain lesions: A systematic review of published cases and case series.
- Author
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Garg, Ravindra Kumar, Paliwal, Vimal, Suvirya, Swastika, Malhotra, Hardeep Singh, and Verma, Anoop
- Abstract
Objective: This systematic review aimed to evaluate the published cases with miliary brain lesions and their etiological factors, clinical manifestations, diagnostic procedures, and outcomes. Methods: A comprehensive search of PubMed, Scopus, Embase, and Google Scholar was conducted using the specified search strategy. Eligibility criteria included cases with miliary lesions in the brain confirmed through neuroimaging and various diagnostic procedures. The PRISMA guidelines were followed, and the PROSPERO registration number for the protocol is CRD42023445849. Results: Data from 130 records provided details of 140 patients. Tuberculosis was the primary cause in 93 cases (66.4%), malignancies in 36 cases (25.7%), and other causes accounted for the remaining 11% cases. Tuberculosis patients averaged 35.7 years old, while those with malignancies averaged 55.44 years. Tuberculosis symptoms primarily included fever, headache, and altered sensorium, whereas malignant cases often exhibited progressive encephalopathy, headache, and specific neurological deficits. Distinctive indicators for CNS tuberculosis were choroidal tubercles and paradoxical reactions. Additionally, 63 tuberculosis patients showed miliary lung shadows and 49 had abnormal CSF findings. For the malignancy group, 13 exhibited miliary lung lesions, and 8 had CSF abnormalities. Regarding outcomes, a significant mortality disparity was observed, with 58.3% in the malignancy group, compared to 10.8% in the tuberculosis group and 27.3% in other cases. Conclusion: Miliary brain lesions are a crucial imaging abnormality that necessitates prompt work up. In an immunocompromised state, diagnostic possibilities of miliary brain lesions are more varied and often pose a bigger challenge. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
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222. Calvarial Tuberculosis Mimicking Meningioma: An Unusual Cause for Aphasia with Scalp Swelling
- Author
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Krishnakumar P, P P Sathi, Biju Bhadran, and A Raghunath
- Subjects
meningioma mimic ,medicine.medical_specialty ,medicine.medical_treatment ,lcsh:Surgery ,lcsh:RC346-429 ,030218 nuclear medicine & medical imaging ,Meningioma ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Parenchyma ,medicine ,cns tuberculosis ,Craniotomy ,lcsh:Neurology. Diseases of the nervous system ,business.industry ,lcsh:RD1-811 ,calvarial tuberculosis ,medicine.disease ,medicine.anatomical_structure ,Scalp ,Histopathology ,Sarcoma ,Radiology ,Differential diagnosis ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background Calvarial tuberculosis is uncommon. It usually presents as a punched out lesion with varying extend of extradural and subgaleal collection. However, typical imaging findings may be lacking and may appear as a neoplasm-like meningioma. This report details the clinical and imaging findings of a left frontal lesion which mimicked neoplasm. Clinical Presentation A 54-year-old female patient presented with decreased speech output and a gradually growing swelling on the left side of the scalp for 1 year duration. On imaging, lesion was left frontal subgaleal plane and left frontal parenchyma with different signal changes. Bony changes were minimal. Our preoperative diagnosis was a central nervous system tumor-like convexity meningioma with an extracranial growth or a dural-based sarcoma or slow-growing metastasis. The patient underwent left frontal craniotomy and excision of the lesion. Histopathology was suggestive of tuberculous granuloma. Conclusion Our report represented a case of diffuse variety of calvarial tuberculosis with significant growth into brain parenchyma which is rare. It should be kept as one of the differential diagnosis of lesions with intracranial and scalp component. Awareness will help in managing and prognosticating these lesions.
- Published
- 2016
223. Improved diagnosis of central nervous system tuberculosis by MPB64-Target PCR Diagnóstico da tuberculose do sistema nervoso central por MPB64-Target PCR
- Author
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Dil-Afroze, Abdul Waheed Mir, Altaf Kirmani, Shakeel-ul-Rehman, Rafiqa Eachkoti, and Mushtaq A. Siddiqi
- Subjects
tuberculomas intracraniais ,intracranial tuberculomas ,PCR ,meningite tuberculosa ,lcsh:QR1-502 ,Mycobacterium tuberculosis ,tuberculous meningitis (TBM) ,lcsh:Microbiology ,tuberculose do sistema nervoso central ,CNS tuberculosis - Abstract
Central nervous system (CNS) tuberculosis is a serious clinical problem, the treatment of which is sometimes hampered by delayed diagnosis. Clearly, prompt laboratory diagnosis is of vital importance as the spectrum of disease is wideand abnormalities of the cerebrospinal fluid (CSF) are incredibly variable. Since delayed hypersensitivity is the underlying immune response, bacterial load is very low. The conventional bacteriological methods rarely detect Mycobacterium tuberculosis in CSF and are of limited use in diagnosis of tuberculous meningitis (TBM). This double blind study was, therefore, directed to the molecular analysis of CNS tuberculosis by an in-house-developed PCR targeted for amplification of a 240bp nucleotidesequence coding for MPB64 protein specific for Mycobacterium tuberculosis. Based on the clinical criteria, 47 patients with CNS tuberculosis and a control group of 10 patients having non-tubercular lesions of the CNS were included in the study. Analyses were done in three groups; one group consisting of 27 patients of TBM, a second group of 20 patients with intracranial tuberculomas and a third group of 10 patients having non-tubercular lesions of the CNS acted as control. There were no false positive results by PCR and the specificity worked out to be 100%. In the three study groups, routine CSF analysis (cells and chemistry), CSF for AFB smear and culture were negative in all cases. PCR was positive for 21/27 patients (77.7% sensitivity) of the first group of TBM patients, 6/20 patients (30% sensitivity) of the second group with intracranial tuberculomas were positive by PCR and none was PCR-positive (100% specificity) in the third group. Thus, PCR was found to be more sensitive than any other conventional method in the diagnosis of clinically suspected tubercular meningitis.A tuberculose do sistema nervoso central (CNS) é um problema clínico sério, cujo tratamento é dificultado pelo diagnóstico tardio. O diagnóstico laboratorial rápido é de importância vital considerando que o espectro da doença é amplo e as anormalidades do liquor são muito variáveis. Considerando que a hipersensibilidade tardia é a resposta imune fundamental, a carga bacteriana é muito baixa. Os métodos bacteriológicos convencionais raramente detectam Mycobacterium tuberculosis no liquor e são de uso limitado para diagnóstico da meningite tuberculosa (TBM). O presente estudo duplo-cego objetivou a análise molecular da tuberculose do CNS através de um PCR desenvolvido in-house direcionado para a amplificação de uma seqüência de nucleotídios de 240pb que codificam a proteína MPB64 especifica de Mycobacterium tuberculosis. Baseando-se em critérios clínicos, selecionou-se 47 pacientes com tuberculose do CNS e um grupo controle de 10 pacientes com lesões não-tuberculosas no CNS. As análises foram divididas em três grupos: um grupo de 27 pacientes com TBM, um segundo grupo com 20 pacientes com tuberculomas intracraniais e um terceiro grupo de 10 pacientes com lesões não-tuberculosas no CNS (controles). O PCR não forneceu nenhum resultado falso-positivo, com 100% de especificidade. Em todos os três grupos de estudo, os resultados das análises de rotina do liquor por histologia, química e baciloscopia e também cultura foram negativos em todos os casos. No primeiro grupo de pacientes com TBM, PCR foi positivo em 21/27 pacientes (sensibilidade de 77,7%). No segundo grupo de pacientes com tuberculomas intracraniais, 6/20 foram positivos (sensibilidade de 30%). Nenhum dos pacientes do grupo controle foi positivo (100% de especificidade). Dessa forma, o PCR mostrou-se mais sensível que os métodos convencionais no diagnóstico de casos suspeitos de meningite tuberculosa.
- Published
- 2008
224. Les aspects en imagerie de la tuberculose du système nerveux central
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N. Aziz, M. Benameur, S. Semlali, S. Chaouir, S. Akjouj, M. Mahi, A. El Kharras, and Y. Hsaini
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Pathology ,medicine.medical_specialty ,Tuberculosis ,Radiological and Ultrasound Technology ,business.industry ,CNS TUBERCULOSIS ,medicine ,Cardiovascular diagnosis ,Radiology, Nuclear Medicine and imaging ,Tuberculoma ,medicine.disease ,Nuclear medicine ,business - Abstract
CNS tuberculosis remains relatively frequent in endemic regions. Both CT and MRI are valuable for diagnosis. Even though non-specific, MRI including diffusion-weighted imaging and proton spectroscopy is more sensitive than CT for detection of some lesions. The purpose of this paper is to illustrate the imaging features of CNS tuberculosis.
- Published
- 2008
225. Neuromyelitis optica spectrum disorder (NMOSD) with hypothalamic involvement and central nervous system tuberculosis: A case report
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Luis F. Rivera-Chávez, Manuel S. López-Martínez, and Adib Jorge de Saráchaga
- Subjects
Pathology ,medicine.medical_specialty ,Neuromyelitis optica ,Tuberculosis ,business.industry ,Central nervous system ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,CNS TUBERCULOSIS ,medicine ,Surgery ,Spectrum disorder ,Neurology (clinical) ,business - Published
- 2020
226. A complicated case of altered sensorium.
- Author
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Vikram, Kushaal, KN, Shivashankara, Chakraborty, Joydeep, and Umakanth, Shashikiran
- Subjects
BRAIN ,RADIOGRAPHY ,DRUG therapy for tuberculosis ,TUBERCULOSIS diagnosis ,ANTITUBERCULAR agents ,FACIAL paralysis ,MAGNETIC resonance imaging ,MALARIA ,NEUROLOGIC manifestations of general diseases ,TOMOGRAPHY ,TUBERCULOSIS ,HORNER syndrome ,SYMPTOMS - Abstract
Tuberculosis and malaria are two common diseases afflicting the population of the Indian subcontinent. Both are associated with fatal neurological complications. Clinically, it may be difficult to differentiate between the two, except for that the focal neurological complications are more common with central nervous system (CNS) tuberculosis than with cerebral malaria. We report the case of a 48-year-old woman who presented with a history of fever and altered sensorium of short duration. She was initially treated for falciparum malaria on the basis of positive peripheral smear and normal CT scan of the brain, but later on diagnosed to have CNS tuberculosis on the basis of persistence of symptoms, development of focal neurological symptoms and MRI of the brain showing multiple tuberculomas. She improved significantly with a course of antitubercular treatment (ATT) and systemic corticosteroids. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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227. TUBERCULAR MENINGITIS WITH CONCURRENT INTRACRANIAL AND INTRA-SPINAL TUBERCULOMAS
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Peter George, Rajesh K Shetty, Sampath Kumar, Jayaprakash Shetty, and Amit Agrawal
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Pathology ,medicine.medical_specialty ,Tuberculosis ,business.industry ,Central nervous system ,Pulmonary disease ,General Medicine ,medicine.disease ,Spinal cord ,Lower motor neuron ,medicine.anatomical_structure ,CNS TUBERCULOSIS ,medicine ,Tuberculoma ,business ,Meningitis - Abstract
Central nervous system (CNS) tuberculosis commonly manifests as tubercular meningitis CNS tuberculomas are more common intracranially and less frequently involve the spinal cord. We report an unusual case of CNS tuberculosis presented with predominant features of tubercular meningitis with concurrent intra-cranial and intra-medullary tuberculomas in any evidence of pulmonary disease. Most noticeable feature of this patient was lower motor neuron type of bladder involvement in the beginning of clinical deterioration that led to the discovery of intra-spinal tuberculoma.
- Published
- 2007
228. TO EVALUATE THE SENSITIVITY AND SPECIFICITY OF CSF-ADA AS A DIAGNOSTIC TOOL IN TUBERCULOSIS MENINGITIS
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Ishan Parasher, Shrawan Kumar, Karthic Chandran, Pranjal Pankaj, and Manish Kumar Singh
- Subjects
medicine.medical_specialty ,Tuberculosis ,biology ,Tuberculosis Meningitis ,business.industry ,Aseptic meningitis ,medicine.disease ,Tuberculous meningitis ,Adenosine deaminase ,Cerebrospinal fluid ,Internal medicine ,CNS TUBERCULOSIS ,medicine ,biology.protein ,business ,Meningitis - Abstract
INTRODUCTION: Tuberculosis remains one of the world’s deadliest diseases & tubercular meningitis is one of the most deadly complications due to missed diagnosis and delayed treatment result in significant morbidity and mortality. The signs and symptoms, results of routine analysis of CSF and radiographic findings for patients with CNS tuberculosis are often inadequate in making a definitive diagnosis. AIMS AND OBJECTIVES: 1. To study the levels of Adenosine deaminase in cases of meningitis, 2. To evaluate the sensitivity and specificity of CSF-ADA as a diagnostic test in tuberculosis meningitis. MATERIAL AND METHODS: In the cross sectional study, Adenosine deaminase activity (ADA) was studied in cerebrospinal fluid of 60 cases of tuberculous meningitis, 10 cases of pyogenic meningitis. 10 cases of aseptic meningitis and15 control. RESULTS: The mean CSF-ADA activity was 14.1±1.96 (tuberculous meningitis); 4.92±1.27 (pyogenic meningitis); 3.66±1.03 (aseptic meningitis) and 1.69±0.44 U/l (control) respectively. The sensitivity and specificity of this test for diagnosis of tuberculous meningitis was 100% and 97.44% respectively with ADA value of more than 10 U/L. CONCLUSION: The adenosine deaminase activity in tuberculous meningitis cases was significantly higher. So it can be of great value in the early and more definitive diagnosis of tuberculous meningitis, to help early diagnosis and treatment to prevent from deadly complications of tubercular meningitis.
- Published
- 2013
229. Magnetic Resonance Imaging in Diagnosis of Childhood Central Nervous System Tuberculosis.
- Author
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Uysal, C., Göse, G., Güven, A., and Diren, B.
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MAGNETIC resonance imaging ,CENTRAL nervous system diseases ,DIAGNOSTIC imaging ,BRAIN stem ,BLOOD circulation disorders ,PERIPHERAL nervous system ,EVALUATION of medical care - Abstract
Background: We investigated the role of magnetic resonance imaging (MRI) in diagnosis of central nervous system (CNS) tuberculosis. Patients and Methods: The FRI findings (T1, T2 and T1 sequence after contrast) of 11 children with CNS tuberculosis were evaluated and the diagnostic value of contrast enhanced MRI and its correlation with the clinical findings were investigated. Results: The median age of the patients was 6 years; seven were male and four female. FRI findings of the cases were meningeal enhancement (90.9%), hydrocephalus (63.6%), infarction (45.5%), tuberculomas (27.2%), cranial nerve involvement (27.2%) and severe cortical atrophy (9.1%). FRI provided early diagnosis in two cases by demonstrating tuberculomas, and supported the diagnosis in seven cases. However, in two cases FRI findings were inadequate to diagnose CNS tuberculosis, especially at the beginning. Conclusion: Contrast enhanced MRI is a very useful technique for diagnosing CNS tuberculosis, particularly by demonstrating the localized lesions, meningeal enhancement and the brain stem. However, a family history of tuberculosis, chest X-ray findings and the clinical picture are still very important for diagnosis. [ABSTRACT FROM AUTHOR]
- Published
- 2001
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230. Natural course of epilepsy concomitant with CNS tuberculomas
- Author
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Thamer Al-Khairallah, Fahad Alrabiah, Salah Baz, Abdulrahman A. Alrajhi, Abdulaziz Alsemari, Abid Kareem, and Najeeb Qadi
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Male ,medicine.medical_specialty ,Pediatrics ,Natural course ,Epilepsy ,Tuberculosis ,business.industry ,Antitubercular Agents ,medicine.disease ,Surgery ,Tuberculoma, Intracranial ,Neurology ,Concomitant ,CNS TUBERCULOSIS ,medicine ,Humans ,Female ,Tuberculoma ,In patient ,Neurology (clinical) ,business ,Retrospective Studies - Abstract
Summary Background Epilepsy is relatively common in CNS tuberculomas, but its natural course is unclear. Aim To determine the prevalence and prognosis of epilepsy in patients with seizures related to CNS tuberculomas. Methods We retrospectively reviewed the charts of patients with CNS tuberculomas who presented at our institution between 1983 and 2001. Results Seizures occurred in 22 of 93 (23.6%) of the patients with CNS tuberculomas. These patients were treated with standard antituberculous therapy for a period varying between 6 and 20 months. Sixty-three out of 93 patients were cured of tuberculosis, and 21 of the 63 (33%) who had concomitant epilepsy became seizure-free. TB recurred in 3 patients, and 1 out of 22 who had concomitant epilepsy continued to have seizures; 3 died and 24 were lost to follow-up. Anti-epileptic medications were discontinued after completion of the anti-TB course. Conclusion Seizures are commonly associated with CNS tuberculomas and most often resolve after successful treatment of the underlying CNS tuberculosis.
- Published
- 2012
231. A rare cause of temporal lobe ring-enhancing lesion
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Sahil Mehta, Vivek Lal, Chirag Kamal Ahuja, Anu Gupta, Manish Modi, Manoj Kumar Goyal, and Biplab Das
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Pathology ,medicine.medical_specialty ,Contrast enhancement ,business.industry ,medicine.disease_cause ,Hyperintensity ,Temporal lobe ,Herpes simplex virus ,Mental state ,CNS TUBERCULOSIS ,Cases ,medicine ,Enhancing Lesion ,Neurology (clinical) ,business ,Mri findings - Abstract
A 65-year-old man presented with fever, seizures, and altered mental state of 10 days duration. He was initially diagnosed with CNS tuberculosis at another medical center based on MRI findings (figure 1). Repeat MRI by our center 1 week later revealed bilateral temporal, insular, and inferior frontal hyperintensities with gyral contrast enhancement (figure 2). CSF herpes simplex virus (HSV) PCR was positive. The patient was started on IV acyclovir. At 6-month follow-up, he is independent in activities of daily living.
- Published
- 2015
232. Multiple tuberculomas and cavitating pulmonary tuberculosis in an infant.
- Author
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Peterson, Rachel, Ramya, R, Kuruvilla, Asha, and Lakshmi, K
- Subjects
- *
TUBERCULOMA , *TUBERCULOSIS , *INFANTS , *COUGH , *TUBERCULOUS meningitis , *PRIMARY immunodeficiency diseases , *CENTRAL nervous system - Abstract
A five-month-old infant presented with fever and cough for 3 weeks. She was diagnosed with multiple tuberculomas and cavitating pulmonary tuberculosis. She was a household contact of an open case of tuberculosis (TB) and developed severe disease, although she had received the Bacillus Calmette–Guérin (BCG) vaccine and had no primary or secondary immunodeficiency. In infants, due to low levels of cell mediated immunity, tuberculosis can be severe and dissemination of tuberculosis to the central nervous system (CNS) can occur very early without following the usual time frame. CNS TB may not have symptoms in the early stages in infants and may require neuroimaging for diagnosis. This is the youngest child that has been reported with multiple CNS tuberculomas. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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233. Intracranial Tuberculoma Mimicking Neurosarcoidosis: A Clinical Challenge.
- Author
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Abbasi, Fatemah, Ozer, Muhammet, Juneja, Kirti, Goksu, Suleyman Yasin, Mobarekah, Babak Jamasian, and Whitman, Marc S.
- Subjects
SARCOIDOSIS ,DIAGNOSIS ,SYMPTOMS ,INTRACRANIAL hypertension ,CENTRAL nervous system ,HIV infections ,TUBERCULOMA - Abstract
Central nervous system (CNS) tuberculosis is a rare manifestation of all tuberculosis presentations. The incidence of brain tuberculoma is increasing in developed countries due to HIV infection and immigration from tuberculosis-endemic countries. Symptoms and radiologic findings of CNS tuberculosis can be non-specific and lead to misdiagnosis or mistreatment. Intracranial tuberculoma can present with a seizure, intracranial hypertension, or focal neurologic symptoms. In our case, the diagnosis was challenging between neurosarcoidosis and intracranial tuberculoma due to inconclusive results of stereotactic brain biopsy and clinical presentation. The pathology result of the open brain biopsy revealed non-caseating granuloma. Finally, we were able to diagnose intracranial tuberculoma following acid-fast bacilli culture results of open brain biopsy. This report highlights the importance of including intracranial tuberculoma in the differential diagnosis of cerebral space-occupying lesions, even in patients with negative laboratory findings of tuberculosis. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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234. Mycobacterium tuberculosis Infection Induces BCSFB Disruption but No BBB Disruption In Vivo: Implications in the Pathophysiology of Tuberculous Meningitis.
- Author
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Sánchez-Garibay, Carlos, Salinas-Lara, Citlaltepetl, Gómez-López, Marcos Artemio, Soto-Rojas, Luis O., Castillón-Benavides, Nidia Karen, Castillón-Benavides, Omar Jorge, Hernández-Campos, María Elena, Hernández-Pando, Rogelio, Marquina-Castillo, Brenda, Flores-Barrada, Manuel Alejandro, Choreño-Parra, José Alberto, León-Contreras, Juan Carlos, Tena-Suck, Martha Lilia, Mata-Espinosa, Dulce Adriana, Nava, Porfirio, Medina-Mendoza, Jessica, and Rodríguez-Balderas, Cesar Augusto
- Subjects
TUBERCULOUS meningitis ,TUBERCULOSIS ,MYCOBACTERIUM tuberculosis ,MYCOBACTERIAL diseases ,CENTRAL nervous system ,CHOROID plexus ,PATHOLOGICAL physiology - Abstract
Central nervous system (CNS) tuberculosis is the most lethal and devastating form among the diseases caused by Mycobacterium tuberculosis. The mechanisms by which M. tuberculosis bacilli enter the CNS are still unclear. However, the BBB and the BCSFB have been proposed as possible routes of access into the brain. We previously reported that certain strains of M. tuberculosis possess an enhanced ability to cause secondary CNS infection in a mouse model of progressive pulmonary tuberculosis. Here, we evaluated the morphostructural and molecular integrity of CNS barriers. For this purpose, we analyzed through transmission electron microscopy the ultrastructure of brain parenchymal microvessels and choroid plexus epithelium from animals infected with two mycobacterial strains. Additionally, we determined the expression of junctional proteins and cytokines by immunological techniques. The results showed that the presence of M. tuberculosis induced disruption of the BCSFB but no disruption of the BBB, and that the severity of such damage was related to the strain used, suggesting that variations in the ability to cause CNS disease among distinct strains of bacteria may also be linked to their capacity to cause direct or indirect disruption of these barriers. Understanding the pathophysiological mechanisms involved in CNS tuberculosis may facilitate the establishment of new biomarkers and therapeutic targets. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
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235. Acanthamoeba meningoencephalitis in an immunocompetent patient: An autopsy case report
- Author
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Afshan Jabeen, Megha S Uppin, Sundaram Challa, Rajesh Reddy, Mudumba Vijayasaradhi, and Rupam Borghain
- Subjects
Pathology ,medicine.medical_specialty ,Tuberculosis ,biology ,business.industry ,Autopsy ,General Medicine ,Autopsy case ,Acanthamoeba Meningoencephalitis ,medicine.disease ,biology.organism_classification ,Pathology and Forensic Medicine ,Acanthamoeba ,CNS TUBERCULOSIS ,medicine ,Neurology (clinical) ,Differential diagnosis ,Granulomatous amoebic encephalitis ,business - Abstract
Chronic granulomatous CNS infections may be caused by tuberculosis, fungi and rarely by free-living amoeba, especially in immunocompromised individuals. We report a rare, fatal case of granulomatous amoebic encephalitis in an immunocompetent patient mimicking CNS tuberculosis, and review the imageological features and diagnostic tests.
- Published
- 2011
236. MRI in intracranial tuberculosis: Have we seen it all?
- Author
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Baloji, Abhiman and Ghasi, Rohini Gupta
- Subjects
- *
TUBERCULOSIS , *HIV infections , *DIAGNOSTIC imaging , *OVERPOPULATION , *POPULATION geography , *SPINAL tuberculosis - Abstract
Tuberculosis is emerging worldwide across diverse populations and geographies; unrestricted by the social divide and the geographical barriers in today's interconnected world. This rise in its prevalence can be linked to multiple factors including urbanisation, spurt in global travel, population explosion, migration and HIV infection. The varied and complex clinical presentation of intracranial tuberculosis tricks even the best of the clinicians. This along with the other facets associated with its management including drug resistance, paradoxical reaction, underlying HIV infection can make it particularly challenging. Imaging has a definitive role in the evaluation and follow-up of intracranial tuberculosis and MRI is the cornerstone in this regard. Typical features of intracranial tuberculosis are well-described. However, it is not infrequent to encounter atypical and bizarre presentations, both clinically and on imaging. A holistic clinical and imaging review of difficult cases, including newer MRI techniques, is necessary for the neuroradiologist, neurologist and the neurosurgeon to arrive at the right diagnosis in a timely fashion. • Intracranial tuberculosis is emerging across the globe. • Imaging studies, particularly MRI is the cornerstone in the diagnosis. • Typical and atypical features contribute to a diverse imaging pattern. • Knowledge of the various possibilities and advanced MRI techniques is essential. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
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237. Involvement of the Choroid Plexus in Neurotuberculosis: MR Findings in Six Cases
- Author
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Dibyajyoti Boruah, Jayantee Kalita, A. Bhattacharyya, Vivek Singh, Akash Handique, U.K. Misra, and R.V. Vishnu Phadke
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Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,eye diseases ,Tuberculous meningitis ,Hydrocephalus ,Edema ,CNS TUBERCULOSIS ,medicine ,Radiology, Nuclear Medicine and imaging ,Choroid plexus ,sense organs ,Neurology (clinical) ,medicine.symptom ,business ,Meningitis - Abstract
The majority of intracranial infections that cause meningitis are considered to start in the choroid plexus of the ventricles, but lesions involving the choroid plexus are rare. There are isolated case reports of the involvement of choroid plexus in tuberculous meningitis. The main imaging findings are abnormal enhancement of the thickened choroid plexus, asymmetric hydrocephalus with sequestrated temporal horn, periventricular edema and intraventricular septae formation. Six patients having tubercular involvement of choroid plexus were treated at our institution. This is probably the largest series of tubercular involvement of choroid plexus highlighting the imaging features of this rare manifestation of CNS tuberculosis.
- Published
- 2010
238. Extrapulmonary tuberculosis presenting as a cavernous sinus syndrome: Case report with review of existing literature
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Amee Patrawalla and Shashi Kapadia
- Subjects
medicine.medical_specialty ,Tuberculosis ,Lymph node biopsy ,Case Report ,Infectious and parasitic diseases ,RC109-216 ,Prednisone ,medicine ,Tuberculoma ,FDG-PET ,Extrapulmonary tuberculosis ,CNS tuberculosis ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Surgery ,Subcarinal Lymph Node ,Regimen ,Infectious Diseases ,Granuloma ,Cavernous sinus ,business ,Cavernous sinus syndrome ,medicine.drug - Abstract
Tuberculoma involving the cavernous sinus is a rare presentation of CNS disease, with only twelve cases reported in previous literature. We report a case of a 48 year old woman who presented with a right cavernous sinus syndrome of 2 months duration. MRI showed a mass in the right cavernous sinus, and serologic workup revealed an elevated sedimentation rate and positive Quantiferon®-GOLD testing. 18-FDG PET-CT demonstrated a hypermetabolic 3cm subcarinal lymph node, and lymph node biopsy showed caseating granuloma. Culture of lymphatic tissue grew drug-sensitive M. tuberculosis. The patient was treated with a non-standard 4-drug regimen and prednisone, with rapid improvement of symptoms and radiologic abnormalities. Total length of treatment was 12 months. In addition, we review the 12 cases found in literature, and discuss clinical features, diagnostic dilemmas, and approaches to treatment.
- Published
- 2014
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239. Intramedullary spinal tuberculosis in pregnancy: A rare case report
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Sangram Biradar and Shridhar Patil
- Subjects
Pregnancy ,Pediatrics ,medicine.medical_specialty ,Tuberculosis ,business.industry ,General Medicine ,medicine.disease ,Spinal column ,law.invention ,Intramedullary rod ,law ,Infectious disease (medical specialty) ,CNS TUBERCULOSIS ,Rare case ,medicine ,Presentation (obstetrics) ,business - Abstract
Tuberculosis (TB) is an infectious disease which has the pulmonary form as the most common presentation. The spinal column is involved in
- Published
- 2019
240. Disseminated central nervous system tuberculoma in a patient with scrub typhus: A case report.
- Author
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Yu, Yachun and He, Guohua
- Subjects
TSUTSUGAMUSHI disease ,TUBERCULOUS meningitis ,CENTRAL nervous system ,TUBERCULOMA ,MYCOBACTERIUM tuberculosis ,SPINAL cord - Abstract
Central nervous system (CNS) tuberculosis mainly manifests as tuberculous meningitis and intracranial tuberculosis; intramedullary tuberculosis is uncommon. Scrub typhus is an acute naturally occurring infectious disease caused by Orientia tsutsugamushi. CNS tuberculoma following typhus is rare. The present study described a 60-year-old man with high fever, muscle soreness, yellowish skin and sclera and hepatosplenomegaly. At first, the patient was diagnosed with scrub typhus, after treatment with doxycycline he recovered completely. However, half a month after discharge, the patient experienced headache, night sweats and anorexia. Tuberculosis-specific enzyme-linked immunospot assay showed positive Mycobacterium tuberculosis antibody in cerebrospinal fluid (CSF). Metagenomic next-generation sequencing detected the presence of Mycobacterium tuberculosis in CSF. Magnetic resonance imaging of the brain and spinal cord showed multiple rings enhancing lesions in the cerebral hemispheres, cerebellum, brainstem and spinal cords. After the diagnosis of CNS tuberculoma, the patient was started on conventional anti-tuberculosis therapy resulting in a good prognosis. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
241. Intra-Cranial Lesions in a Patient with Hodgkin Lymphoma
- Author
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Douglas J. Rausch, Arun S. Shet, Michael Belzer, and Nabil Saba
- Subjects
Adult ,Male ,Cancer Research ,Pathology ,medicine.medical_specialty ,Tuberculosis ,Biopsy ,Central nervous system ,Ki-1 Antigen ,Disease ,Newly diagnosed ,Polymerase Chain Reaction ,Central Nervous System Neoplasms ,Cerebellum ,Humans ,Medicine ,Lymphocytes ,Stage (cooking) ,Granuloma ,business.industry ,Brain ,Hematology ,Flow Cytometry ,Prognosis ,medicine.disease ,Hodgkin Disease ,medicine.anatomical_structure ,Oncology ,Lymphatic Metastasis ,CNS TUBERCULOSIS ,Hodgkin lymphoma ,Lymph Nodes ,Tomography, X-Ray Computed ,business - Abstract
Central nervous system (CNS) lesions in newly diagnosed, advanced Hodgkin's disease (HD) commonly suggest intracranial involvement with HD. However, occasionally this could be the result of a CNS infection. We report a case of concurrent CNS tuberculosis in a patient with stage III E HD the first reported in the English literature. Management of this case and the literature pertaining to infectious complications of HD are reviewed.
- Published
- 2004
242. Central Nervous System Tuberculosis
- Author
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Vikas Chaudhary, Sachchidanand Yadav, and Shahina Bano
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Tuberculosis ,business.industry ,Central nervous system ,Disease ,Bioinformatics ,medicine.disease ,Insidious onset ,medicine.anatomical_structure ,CNS TUBERCULOSIS ,medicine ,Presentation (obstetrics) ,Latency (engineering) ,business ,Organ system - Abstract
Tuberculosis is a formidable disease worldwide because of its highly infectious nature and propensity for latency. The increasing prevalence of tuberculosis in both immunocompetent and immunocompromised individuals in recent years makes this disease a topic of universal concern. The disease has insidious onset and can affect virtually any organ system in the body, including the central nervous system (CNS). The CNS tuberculosis can mimic a number of other disease entities, and therefore it is important to be familiar with the various radiologic features of CNS tuberculosis to ensure early, accurate diagnosis. In this chapter we discuss various possible presentation of central nervous system tuberculosis involving the brain and spine.
- Published
- 2012
243. Central nervous system tuberculosis
- Author
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Rakesh K. Gupta and Sunil Kumar
- Subjects
Tuberculosis ,Magnetic Resonance Spectroscopy ,Central nervous system ,Perfusion scanning ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Magnetization transfer imaging ,medicine.diagnostic_test ,business.industry ,Brain ,Magnetic resonance imaging ,General Medicine ,Tuberculosis, Central Nervous System ,equipment and supplies ,medicine.disease ,Magnetic Resonance Imaging ,Proton magnetic resonance ,medicine.anatomical_structure ,Diffusion Magnetic Resonance Imaging ,Tuberculoma, Intracranial ,CNS TUBERCULOSIS ,Tuberculoma ,Neurology (clinical) ,business ,human activities ,Neuroscience - Abstract
Central nervous system (CNS) tuberculosis is frequently encountered in tropical countries. Imaging plays an important role in its recognition and in its differentiation from other similar conditions. Specific magnetic resonance techniques, such as magnetization transfer imaging, proton magnetic resonance spectroscopy, diffusion, and perfusion imaging are useful in its characterization and management. This article reviews the various forms of CNS tuberculosis, including its complications and imaging features.
- Published
- 2011
244. Isolated pontine tuberculoma presenting as 'fou rire prodromique'
- Author
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Syed Amjad Ali Rizvi, Ibne Ahmad, Kaleem Ahmad, Jamal Akhtar, Mohammed Azfar Siddiqui, and Ekram Ullah
- Subjects
Pathological laughter ,Pathology ,medicine.medical_specialty ,Young child ,business.industry ,General Medicine ,X ray computed ,Clinical information ,CNS TUBERCULOSIS ,Medicine ,Tuberculoma ,Radiology ,Ct findings ,business ,Tuberculin test - Abstract
The authors present the case of a young child with “fou rire prodromique” as an initial manifestation of pontine tuberculoma. This report is the first description of fou rire prodromique as the presenting sign of CNS tuberculosis. The combination of clinical information and CT findings allowed for precise localization of the lesion and suggested tuberculoma as the possible etiology.
- Published
- 2012
245. Central nervous system infections
- Author
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Avindra Nath and Gloria von Geldern
- Subjects
medicine.anatomical_structure ,business.industry ,CNS TUBERCULOSIS ,Central nervous system ,medicine ,Bacterial meningitis ,Hsv encephalitis ,medicine.disease ,business ,Cryptococcal meningitis ,Virology ,Encephalitis - Published
- 2015
246. Central Nervous System Tuberculosis: An Imaging-Focused Review of a Reemerging Disease.
- Author
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Sanei Taheri, Morteza, Karimi, Mohammad Ali, Haghighatkhah, Hamidreza, Pourghorban, Ramin, Samadian, Mohammad, and Delavar Kasmaei, Hosein
- Abstract
Central nervous system (CNS) tuberculosis is a potentially life threatening condition which is curable if the correct diagnosis is made in the early stages. Its clinical and radiologic manifestations may mimic other infectious and noninfectious neurological conditions. Hence, familiarity with the imaging presentations of various forms of CNS tuberculosis is essential in timely diagnosis, and thereby reducing the morbidity and mortality of this disease. In this review, we describe the imaging characteristics of the different forms of CNS tuberculosis, including meningitis, tuberculoma, miliary tuberculosis, abscess, cerebritis, and encephalopathy. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
247. Diagnóstico da tuberculose do sistema nervoso central por MPB64-Target PCR
- Author
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Mushtaq A. Siddiqi, Dil-Afroze, Shakeel-ul-Rehman, Altaf Rehman Kirmani, Rafiqa Eachkoti, and Abdul Waheed Mir
- Subjects
Pathology ,medicine.medical_specialty ,Tuberculosis ,Disease ,Microbiology ,Tuberculous meningitis ,tuberculose do sistema nervoso central ,Mycobacterium tuberculosis ,Cerebrospinal fluid ,Immune system ,Medicine ,CNS tuberculosis ,tuberculomas intracraniais ,intracranial tuberculomas ,biology ,business.industry ,meningite tuberculosa ,biology.organism_classification ,medicine.disease ,tuberculous meningitis (TBM) ,PCR ,Delayed hypersensitivity ,Medical Microbiology ,business ,Meningitis ,Research Paper - Abstract
Central nervous system (CNS) tuberculosis is a serious clinical problem, the treatment of which is sometimes hampered by delayed diagnosis. Clearly, prompt laboratory diagnosis is of vital importance as the spectrum of disease is wideand abnormalities of the cerebrospinal fluid (CSF) are incredibly variable. Since delayed hypersensitivity is the underlying immune response, bacterial load is very low. The conventional bacteriological methods rarely detect Mycobacterium tuberculosis in CSF and are of limited use in diagnosis of tuberculous meningitis (TBM). This double blind study was, therefore, directed to the molecular analysis of CNS tuberculosis by an in-house-developed PCR targeted for amplification of a 240bp nucleotidesequence coding for MPB64 protein specific for Mycobacterium tuberculosis. Based on the clinical criteria, 47 patients with CNS tuberculosis and a control group of 10 patients having non-tubercular lesions of the CNS were included in the study. Analyses were done in three groups; one group consisting of 27 patients of TBM, a second group of 20 patients with intracranial tuberculomas and a third group of 10 patients having non-tubercular lesions of the CNS acted as control. There were no false positive results by PCR and the specificity worked out to be 100%. In the three study groups, routine CSF analysis (cells and chemistry), CSF for AFB smear and culture were negative in all cases. PCR was positive for 21/27 patients (77.7% sensitivity) of the first group of TBM patients, 6/20 patients (30% sensitivity) of the second group with intracranial tuberculomas were positive by PCR and none was PCR-positive (100% specificity) in the third group. Thus, PCR was found to be more sensitive than any other conventional method in the diagnosis of clinically suspected tubercular meningitis. A tuberculose do sistema nervoso central (CNS) é um problema clínico sério, cujo tratamento é dificultado pelo diagnóstico tardio. O diagnóstico laboratorial rápido é de importância vital considerando que o espectro da doença é amplo e as anormalidades do liquor são muito variáveis. Considerando que a hipersensibilidade tardia é a resposta imune fundamental, a carga bacteriana é muito baixa. Os métodos bacteriológicos convencionais raramente detectam Mycobacterium tuberculosis no liquor e são de uso limitado para diagnóstico da meningite tuberculosa (TBM). O presente estudo duplo-cego objetivou a análise molecular da tuberculose do CNS através de um PCR desenvolvido in-house direcionado para a amplificação de uma seqüência de nucleotídios de 240pb que codificam a proteína MPB64 especifica de Mycobacterium tuberculosis. Baseando-se em critérios clínicos, selecionou-se 47 pacientes com tuberculose do CNS e um grupo controle de 10 pacientes com lesões não-tuberculosas no CNS. As análises foram divididas em três grupos: um grupo de 27 pacientes com TBM, um segundo grupo com 20 pacientes com tuberculomas intracraniais e um terceiro grupo de 10 pacientes com lesões não-tuberculosas no CNS (controles). O PCR não forneceu nenhum resultado falso-positivo, com 100% de especificidade. Em todos os três grupos de estudo, os resultados das análises de rotina do liquor por histologia, química e baciloscopia e também cultura foram negativos em todos os casos. No primeiro grupo de pacientes com TBM, PCR foi positivo em 21/27 pacientes (sensibilidade de 77,7%). No segundo grupo de pacientes com tuberculomas intracraniais, 6/20 foram positivos (sensibilidade de 30%). Nenhum dos pacientes do grupo controle foi positivo (100% de especificidade). Dessa forma, o PCR mostrou-se mais sensível que os métodos convencionais no diagnóstico de casos suspeitos de meningite tuberculosa.
- Published
- 2007
248. Clinicoradiological features of tuberculous meningitis in patients over 50 years of age
- Author
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Arun B Taly, Krishnan Nagarajan, S. G. Srikanth, S Patil, and Peruvumba N. Jayakumar
- Subjects
Male ,medicine.medical_specialty ,Pediatrics ,Tuberculosis ,Short Report ,Tuberculous meningitis ,Basal (phylogenetics) ,medicine ,Humans ,In patient ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Hydrocephalus ,Psychiatry and Mental health ,Tuberculosis, Meningeal ,CNS TUBERCULOSIS ,Female ,Neurology (clinical) ,Tomography, X-Ray Computed ,business ,Meningitis - Abstract
Background and aim: Tuberculous meningitis (TBM) is a debilitating form of CNS tuberculosis with a high morbidity and mortality in spite of treatment. The diagnosis is based on clinical, radiological and laboratory features. The classical CT features of basal exudates, hydrocephalus, infarcts and granulomas have been mostly reported in younger individuals. Our aim was to study imaging features of TB meningitis in adults over the age of 50 years. Materials and methods: Clinical, imaging and laboratory features of 53 adult patients over the age of 50 years (sixth to eighth decades) were studied retrospectively. Diagnosis of TBM was based on clinical and laboratory features. Results: Imaging features were the conspicuous absence of typical features of TBM (ie, basal meningeal enhancement, hydrocephalus, infarcts/granulomas were seen in only a minority of patients). Conclusions: CT features of TBM in elderly patients were few, atypical and non-contributory for diagnosis, probably because of age related immune senescence. Strong clinical suspicion and correlation with laboratory findings is necessary for early diagnosis.
- Published
- 2006
249. Matrix metalloproteinase-9 activity and a downregulated Hedgehog pathway impair blood-brain barrier function in an in vitro model of CNS tuberculosis.
- Author
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Brilha, Sara, Ong, Catherine W. M., Weksler, Babette, Romero, Nacho, Couraud, Pierre-Olivier, and Friedland, Jon S.
- Abstract
Central nervous system tuberculosis (CNS TB) has a high mortality and morbidity associated with severe inflammation. The blood-brain barrier (BBB) protects the brain from inflammation but the mechanisms causing BBB damage in CNS TB are uncharacterized. We demonstrate that Mycobacterium tuberculosis (Mtb) causes breakdown of type IV collagen and decreases tight junction protein (TJP) expression in a co-culture model of the BBB. This increases permeability, surface expression of endothelial adhesion molecules and leukocyte transmigration. TJP breakdown was driven by Mtb-dependent secretion of matrix metalloproteinase (MMP)-9. TJP expression is regulated by Sonic hedgehog (Shh) through transcription factor Gli-1. In our model, the hedgehog pathway was downregulated by Mtb-stimulation, but Shh levels in astrocytes were unchanged. However, Scube2, a glycoprotein regulating astrocyte Shh release was decreased, inhibiting Shh delivery to brain endothelial cells. Activation of the hedgehog pathway by addition of a Smoothened agonist or by addition of exogenous Shh, or neutralizing MMP-9 activity, decreased permeability and increased TJP expression in the Mtb-stimulated BBB co-cultures. In summary, the BBB is disrupted by downregulation of the Shh pathway and breakdown of TJPs, secondary to increased MMP-9 activity which suggests that these pathways are potential novel targets for host directed therapy in CNS TB. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
250. Seizures and epilepsy associated with central nervous system tuberculosis.
- Author
-
Ramos, Ana P and Burneo, Jorge G
- Abstract
• Almost a quarter of the worldwide population is infected with tuberculosis. • Seizures are commonly associated with central nervous system (CNS) tuberculosis, especially in children and HIV-infected patients. • Early treatment of CNS tuberculosis is vital to avoid complications that increase the risk of seizures. • Young age, early onset of seizures during illness, refractory seizures, tuberculoma, cortical involvement, epileptiform discharges, and residual lesions, are risk factors for the development of epilepsy in CNS tuberculosis. Central nervous system (CNS) tuberculosis is a life-threatening condition that usually presents with seizures, particularly in children and HIV-infected patients. Tuberculous meningitis (TBM) and tuberculomas are the two forms of CNS tuberculosis that can present with seizures. Seizures usually resolve after successful treatment of the underlying infection. However, the success of the treatment is usually based on an early diagnosis. Delay in the treatment of CNS tuberculosis increases the risk of its associated complications, such as stroke. This would lead to the development of epilepsy. Early seizures may be related to meningeal irritation and cerebral edema, whereas late seizures are often associated with structural brain lesions that generally require more advanced and prolonged treatment. Risk factors associated with the development of epilepsy include young age, refractory seizures, tuberculoma, cortical involvement, epileptiform discharges, and residual lesions. Treatment of CNS tuberculosis is based on early initiation of appropriate anti-tuberculous drugs, antiseizure medications, and correction of associated predisposing factors. Finally, further research into the mechanisms of seizures and the development of epilepsy in CNS tuberculosis could help improve management of these conditions. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
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