The Hidden Face of Tuberculosis: A Retrospective Study of Central Nervous System Manifestations in Nepal
Sanjeev Kharel1, Suman Acharya1
1Tribhuvan University Institute of Medicine
Objective:

To know the clinico-demographic profile of patients with central nervous system tuberculosis(CNS TB) along with their hospital outcomes.


Background:

Mycobacterium tuberculosis is the cause of (CNS-TB), a group of neurological syndromes with a comparatively high death and morbidity rate. Meningitis is the most frequent symptom of CNS-TB, followed by tuberculoma, tuberculous brain abscess, and Pott's illness. About 1% of cases of tuberculosis are attributed to CNS-TB. 


Design/Methods:

This is a single-centered retrospective study conducted among adult CNS-TB patients in our center over one year. Data collected were demographic characteristics, clinical presentations, investigations, hospital outcomes, and along with the treatment course.


Results:

A total of 61 patients(57.4% males) were diagnosed with CNS TB with a mean age of 42.10(16.96) years. The majority were TB meningitis (55.7%) followed by tuberculoma 13(21.3%) with few cases of tubercular abscess and spinal TB. Common presenting symptoms included fever(62.9%), headache(73.3%), weight loss(31.1%), vomiting(49.1%), seizures(26.2%), altered mental status(47.5%), and only a few cases of facial deviation and of visual loss. On examinations, neck stiffness was positive at 26.2%, and focal neurological deficit was found at 32.8%. Bacteriological and radiological imaging were done. The majority were treated with ATT of which three had side effects like ATT-induced hepatitis and ethambutol toxicity and only seven hydrocephalus cases had a shunt surgery done. The majority were discharged(86.9%) while 16.4% of cases were intubated and one case had mortality. 


Conclusions:

Early diagnosis through various investigations and appropriate management strategy is the cornerstone for the treatment of CNS-TB. More multi-center studies focusing on larger sample sizes are necessary.


10.1212/WNL.0000000000209088
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