Pathology of Tuberculosis of the Nervous System (Tuberculous Meningitis, Tuberculoma, Tuberculous Abscess)

The experimental data collected during this study of a transmissible type of paralysis developing in tuberculous guinea pigs indicate the condition to be a true tuberculous meningitis. We have been able to rule out the possibility that it is due to a non-tuberculous infection of the central nervous system caused by Roemer's virus, or by an atypical herpes virus, or by some bacterium other than the tubercle bacillus. Roemer's virus and herpes could be eliminated from consideration when Berkefeld N filtrates of infectious brain emulsions proved incapable of reproducing the disease. Furthermore, rabbits could be infected as they cannot with Roemer's virus, and the disease elicited in rabbits bears no semblance to herpes encephalitis. No organism other than the tubercle bacillus could be obtained on culturing brain or brain emulsions from experimental cases, and no others were seen in examining fresh smear preparations from the central nervous system. In a modified Noguchi medium a tubercle bacillus possessing atypical staining properties was obtained. This organism was capable of producing the typical paralytic disease when injected intracerebrally into guinea pigs, and also generalized tuberculosis in animals inoculated subcutaneously with it. Typical tuberde bacilli were readily demonstrable in sections of the meninges from animals with the disease, and culture of pieces of brain on Dorset's egg medium usually yielded a growth of tubercle bacilli. Only in the first of the experimental passages, on the other hand, was it possible to demonstrate acid-fast organisms in fresh smear preparations from the central nervous system. This fact and the attributes of the atypically staining organisms encountered in the cultures in Noguchi media will be considered more fully in a subsequent publication. In view of the much discussed question of the filtrability of the tubercle bacillus our observations concerning the failure of this organism to pass a Berkefeld N filter are of interest. No animal in our series inoculated intracerebrally with brain emulsion from either a "spontaneous" or experimental case of tuberculous meningitis failed to develop meningitis, and that rather acutely, while no animal in our series injected with a Berkefeld filtrate of brain emulsion has developed tuberculous meningitis or any other form of tuberculosis. In connection with this observation it must be recalled that the organism was atypical in respect to its staining qualities at least.

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Characterization of antibody activity in oligoclonal immunoglobulin G synthesized within the central nervous system in a patient with tuberculous meningitis.

Journal of Clinical Microbiology ◽

10.1128/jcm.13.1.30-35.1981 ◽

1981 ◽

Vol 13 (1) ◽

pp. 30-35 ◽

Cited By ~ 31

Author(s):

J Kinnman ◽

H Link ◽

A Frydén

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Tuberculous Meningitis ◽

Immunoglobulin G ◽

Antibody Activity ◽

The Central Nervous System

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Tuberculous brain abscess

Journal of Neurosurgery ◽

10.3171/jns.1980.52.3.0419 ◽

1980 ◽

Vol 52 (3) ◽

pp. 419-422 ◽

Cited By ~ 20

Author(s):

P. R. Mata González ◽

Carlos Vázquez Herrero ◽

G. Flambert Joachim ◽

C. Ruiz Ocaña ◽

G. Cobo Sevilla ◽

...

Keyword(s):

Brain Abscess ◽

Tuberculous Meningitis ◽

Previous History ◽

Miliary Tuberculosis ◽

Occipital Region ◽

Content Type ◽

Tuberculous Abscess ◽

History Of ◽

Tuberculous Brain Abscess ◽

Fine Print

✓ An abscess was removed from the left occipital region in a 73-year-old woman with no previous history of tuberculosis. The patient later died from aspiration bronchopneumonia. Autopsy revealed a basilar tuberculous meningitis and miliary tuberculosis in the peritracheal lymphatic glands, the liver, the spleen, and in isolated areas of the lungs. No chronic tuberculous foci were noted in any area. Including this case, only 18 instances of tuberculous abscess have been reported.

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Syringomyelia Developing as an Acute Complication of Tuberculous Meningitis

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100021156 ◽

1997 ◽

Vol 24 (1) ◽

pp. 73-76 ◽

Cited By ~ 9

Author(s):

Abdu Kader Daif ◽

Al Rajeh ◽

Adesola Ogunniy ◽

Amer Al Boukai ◽

Abdulrahman Al Tahan

Keyword(s):

Nervous System ◽

Tuberculous Meningitis ◽

Early Onset ◽

Late Onset ◽

Acute Onset ◽

Limb Weakness ◽

Inflammatory Edema ◽

Underlying Mechanisms ◽

Tuberculosis Meningitis ◽

Uncommon Complication

ABSTRACT:Background:Tuberculosis of the nervous system has protean manifestations. Syringomyelia, though an uncommon complication of it, is usually of late onset.Methods:We report two patients with tuberculosis meningitis who developed syringomyelia acutely. The diagnosis was supported by neuroimaging and findings at laminectomy.Results:The two patients developed syringomyelia between 11 days and 6 weeks of the onset of tuberculous meningitis. They both had cord swelling and softeningConclusions:Acute-onset syringomyelia should be suspected in any patient being treated for tuberculosis meningitis who subsequently develops limb weakness and/or sphincteric dysfunction. Inflammatory edema and cord ischemia appeared to be the underlying mechanisms in these early onset cases rather than arachnoiditis which is important in late-onset cases.

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Tuberculous Meningitis and Central Nervous System Tuberculosis

Neurocritical Care ◽

10.1007/978-3-642-87602-8_37 ◽

1994 ◽

pp. 398-406 ◽

Cited By ~ 1

Author(s):

Erich Schmutzhard ◽

Ulrich Roelcke ◽

Thomas P. Bleck

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Tuberculous Meningitis

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Development and Validation of a New Scoring System for the Early Diagnosis of Tuberculous Meningitis in Adults

10.21203/rs.3.rs-31333/v1 ◽

2020 ◽

Author(s):

Yuying LU ◽

Chen ZHANG ◽

Zhongyang HU ◽

Guang YAO ◽

Qinghua ZHANG ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Tuberculous Meningitis ◽

Scoring System ◽

Clinical Laboratory ◽

Early Stage ◽

Characteristic Curve ◽

Clinical Manifestations ◽

Symptom Duration ◽

Diagnostic Score

Abstract Background The absence of a sufficiently accurate and efficient diagnosis of tuberculous meningitis (TBM) is major obstacle to delayed treatment, and its non-specific clinical manifestations easily mimic the central nervous system infections caused by other causes, including virus, bacteria, and cryptococcus. This study aims to develop and validate a diagnostic score system for TBM in HIV-uninfected adults by simultaneously comparing TBM with viral meningitis (VM), bacterial meningitis (BM), and cryptococcal meningitis (CM). Methods Twenty-nine factors (including clinical, laboratory and imaging) were assessed among 382 patients who satisfied inclusion criteria for TBM (n = 113), VM (n = 143), BM (n = 65) and CM (n = 61). Independent predictors for the diagnosis of TBM were obtained by logistic regression to establish a diagnostic scoring system. The performance of this scoring system was evaluated using a prospective validation cohort. Results Nine factors independently associated with the diagnosis of TBM: symptom duration (10–30 days), systemic symptoms, evidence of extra-central nervous system tuberculosis, cerebrospinal fluid (CSF) leukocyte count (100-500∗106 /mL), CSF neutrophil proportion (20%-75%), CSF protein (> 1 g/L), low serum sodium (< 137 mmol/L), meningeal enhancement, and brain parenchymal nodules (tuberculomas). The CSF neutrophil proportion was assigned a score of 2 and all other factors were assigned a score of 1. A score of at least five was suggestive of TBM with a sensitivity of 85.8% and a specificity of 87.7%, and the area under the receiver operating characteristic curve (AUC) was 0.927. When applied prospectively to an additional 72 patients (21 with TBM, 27 with VM, 14 with BM, and 10 with CM), the sensitivity, specificity, accuracy, and AUC values of this scoring model were 90.5%, 86.3%, 87.5%, and 0.944, respectively. Conclusions For differential diagnosis between TBM and other causes of meningitis (VM,CM and BM), we developed and validated a new weighted scoring system. The application of this scoring system can help diagnose TBM more efficiently in the early stage.

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A Rare Case of Central Nervous System Tuberculosis

Case Reports in Infectious Diseases ◽

10.1155/2014/186030 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5

Author(s):

Ravish Parekh ◽

Alexis Haftka ◽

Ashleigh Porter

Keyword(s):

Central Nervous System ◽

Human Immunodeficiency Virus ◽

Renal Failure ◽

Nervous System ◽

Parietal Lobe ◽

Vasogenic Edema ◽

Middle Eastern ◽

Cross Sectional ◽

Tuberculous Abscess ◽

Immunodeficiency Virus

Intracranial abscess is an extremely rare form of central nervous system (CNS) tuberculosis (TB). We describe a case of central nervous system tuberculous abscess in absence of human immunodeficiency virus (HIV) infection. A 82-year-old Middle Eastern male from Yemen was initially brought to the emergency room due to altered mental status and acute renal failure. Cross-sectional imaging revealed multiple ring enhancing lesions located in the left cerebellum and in bilateral frontal lobe as well as in the inferior parietal lobe on the left. The patient was placed on an empiric antibiotic regimen. Preliminary testing for infectious causes was negative. Chest radiography and CT of chest showed no positive findings. He was not on any immunosuppressive medications and human immunodeficiency virus (HIV) enzyme immunoassay (EIA) test was negative. A subsequent MRI one month later showed profound worsening of the lesions with increasing vasogenic edema and newly found mass effect impinging on the fourth ventricle. Brain biopsy showed focal exudative cerebellitis and inflamed granulation tissue consistent with formation of abscesses. The diagnosis of CNS TB was finally confirmed by positive acid-fast bacilli (AFB) cultures. The patient was started on standard tuberculosis therapy but expired due to renal failure and cardiac arrest.

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