Cerebral Tuberculosis in an Active-duty Military Officer That Led to Tinnitus From a TB Brain Abscess; A Case Report; Case Report.

Tuberculosis has been a pertinent public health problem for both developing and developed nations. For developed nations, military personal has the higher risk since they do travel to developing nations to embark on their duties. Cerebral tuberculosis is rare and if they occur, they tend to manifest as either meningitis or tuberculoma. Tinnitus is more likely in men particularly persons exposed to loud noises along with other causes. We present a case of cerebral tuberculosis induced tinnitus in a 26-year-old male army officer who presented with a one-week episode of convulsive crises and loss of consciousness after being exposed to a loud noise while on duty. Cranial MRI showed right temporo-parietal and left parietal finger-like hyper-signals with edema on Flair and T2. However, brain CT-scan showed right parieto-temporal and left parietal sub cortical hypodensities and finger-like borders without contrast re-uptake. There was strong suspicion for TB brain abscess leading to a possible manifestation of tinnitus in this patient.Case presentationA 26-year-old male army officer presented with chief complaints of convulsive crisis and loss of consciousness when he heard a loud noise while on duty. He fell to the ground and was found unconscious and drooling by a colleague. He was immediately transferred by non-medical means to our hospital for management. The patient experienced rigidity as well as uncontrolled muscle spasms leading to jerky motions which lasted for about one to two minutes and occurred two hours before admission in a non-febrile context. The convulsive crises occurred two hours prior to admission in a non-febrile state. The patient was then worked up for review of systems (ROS)- SpO2 was 98%; RR was 24 cpm, BP = 125/91 mmHg, Pulse =103 bpm, Glasgow coma scale = 15/15, isochoric iso-reactive pupils, blood sugar = 1,11 g/l; Temperature = 37°C. No motor or sensitive deficits, no meningeal signs, no former convulsive crisis, there was symmetry for chest movements, no signs of respiratory distress, resonant percussion sounds. Also, there was no urine incontinence, dysuria, scrotal swelling and external genitalia deformations. No peripheral lymph nodes (cervical, axillary, inguinal) were palpable.Upon checking the labs, WBC: 5.05, HGB: 12.4 g/l, PLT: 313,000 electrolyte panel reveals all normal except moderate hypomagnesemia. HIV 1 and 2 serology was negative, Cardiovascular examination shows PPP, audible heart sounds at all four auscultation points, no MGR and RRR. On respiratory exam; there were no signs of distress, no tracheal deviation, resonant to percussion, CTAB and no CVAT. On abdominal exam; no HSM and normal bowel movement and sounds. Finally, Neurological; no acute distress (NAD), AAOx3, CN 2-12 intact, MME is normal, recall is 3/3, coordination and concentration intact, follows command and no motor or sensory deficits. Did bronchi fibroscopy along with broncho-alveolar lavage, in search of TB by PCR.ConclusionTinnitus remains the second most prevalent service-connected disability. Patients with cerebral TB abscess are at increased risk for this condition.

Immediate and postponed results of surgery of tuberculosis in patients with HIV infection

The objective: to evaluate immediate and postponed results of surgical treatment of tuberculosis (TB) in patients with TB/HIV co-infection.Subjects and methods. 106 patients underwent surgery: 64 patients suffering from pulmonary tuberculosis (81.2% had resections, and 18.8% – thoracoplasty), 36 patients – tuberculous spondylitis (vertebral body resection in combination with anterior spondylodesis), and 6 patients – cerebral TB (removal of tuberculous lesions under neuronavigation). Development of complications in the postoperative period and tuberculosis relapses in the long-term period was assessed.Results. No severe and suppurative complications were observed in the postoperative period in patients with HIV/pulmonary TB and HIV/cerebral TB. In patients with HIV/TB spondylitis, complications were registered in 4/36 (11.1%) cases: in 2/4 – postoperative wound suppuration and in 2/4 – ligature fistulas. No relapse of tuberculosis was reported after lung resection in 45 out of 45 patients availabe for follow-up, after thoracoplasty in 10 out of 12 patients, after surgery due to tuberculous spondylitis – in 25 out of 27 patients, and cerebral tuberculosis – in 5 out of 6.

A rare case of cerebral tuberculosis and paraneoplastic encephalitis

Voltage gated potassium channel (VGKC) antibodies are seen in many conditions including limbic encephalitis. It typically involves medial temporal lobe, and in rare instances, bilateral cerebellar lobes. Patients can present with seizures and often with alerted mental status and hallucinations. Cerebral tuberculosis (TB)tends to prefer posterior fossa and patients typically present with headache, seizures, and confusion. However, there is no particular association between VGKC encephalitis and disseminated tuberculosis. Presence of both may limit treatment options for paraneoplastic encephalitis. We present a case of a young female with disseminated TB who was also found to have atypical radiographic presentation of TB encephalitis/meningitis and VGKC antibody concerning for paraneoplastic encephalitis. The patient received treatment with steroids and immunoglobulin therapy along with treatment for disseminated tuberculosis. Overall, treatment of paraneoplastic encephalitis is limited in the presence of disseminated TB and a multidisciplinary approach should be used and clinical improvement should be monitored.

Falx cerebri tuberculoma mimicking en plaque meningioma – case report

Background: The involvement of falx cerebri in tuberculosis is extremely rare, with only three cases reported so far in the literature. The diagnosis is most often difficult to establish, given the location of the lesion, making surgical intervention necessary for a definite histopathologic diagnosis. Methods: We present the case of a 49-year old female patient who was admitted for a right jacksonian seizure, followed by a right crural monoparesis, without a history of tuberculosis. The lesion mimicked a falx cerebri en plaque meningioma in the imaging tests. Results: A complete surgical excision was performed through a left fronto-parietal parasagittal approach. The histopathological examination revealed a case of cerebral tuberculosis. The surgical treatment was complemented postoperatively with antituberculous therapy. Conclusion: In this article, we emphasize the rarity of the lesion at this level and also presenting similar cases from the literature. Moreover, we also discuss epidemiological, clinical, imaging, therapeutic as well as pathological aspects of en-plaque dural tuberculoma.