CENTRAL NERVOUS SYSTEM TUBERCULOSIS, PRESENTATION, DIAGNOSIS AND MANAGEMENT: A CASE SERIES.

Abstract

Background: Central nervous system Tuberculosis (CNS TB) presents a diagnostic challenge as well as significant difficulty in definitive management given the variable presentation and potential differentials in diagnosis. We present four cases with confirmed CNS Tuberculosis to highlight the diagnostic difficulty at presentation, and challenges in differentiating from other pathologies. Methods: Sequential cases of patients who subsequently were found to have CNS TB were reviewed. All patients had undergone previous clinical work-up at other institutions. We reviewed investigation techniques used to establish the diagnosis of CNS TB. Results: Four cases were identified comprising 3males and 1 female ranging in age from 22-63years. Two were newly diagnosed as HIV positive. Magnetic resonance imaging demonstrated intra-axial enhancing lesions (2 cases), an extra-axial mass (1) and arachnoiditis (1). Patients had previsouly been managed as having CNS tumours (2 cases), toxoplasmosis (1 case) and 1 patient presented in.  Serum tests were of low yield and eventual CNS TB diagnosis was established with formal histology (2cases), CSF Gene-Expert (1 case) and Urine lipoaribomannan (Urine LAM). The patient with arachnoiditis is deceased but the other 3 have made clinical and radiological improvement on appropriate treatment. Conclusion: TB remains the great mimicker of various pathologies. CNS TB remains a diagnostic challenge due to the often non-specific presentation of the disease. We present various strategies employed in our institution to diagnose CNS TB. A multidisciplinary approach is recommended to optimize care in these patients.