The aim of this study was to study the diagnostic parameters in brain tuberculosis (meningeal and parenchymal) Material and Methods: This study was conducted in the department of Neurosurgery and Neurology SKIMS for a period of two...
moreThe aim of this study was to study the diagnostic parameters in
brain tuberculosis (meningeal and parenchymal)
Material and Methods: This study was conducted in the
department of Neurosurgery and Neurology SKIMS for a period
of two years. A total of 61 patients presenting with brain
tuberculosis admitted at skims during these two years were
included in the study.
Results: The most presenting symptom in our study was headache
found in 95.10% followed by vomiting found in 86.90% of
subjects, fever in 78.70%, altered sensorium in 49.20%, seizures in
19.70% and diplopia in18%. Out of 61 patients cranial nerve
involment was found in 34(55.73%) with 11 having more than two
cranial nerves involved. The most common cranial nerve involved
were 3rd and 6th. ADA was positive in 36 of 53 patients of TBM
with a sensitivity of 67.9% and a specificity of 75%. PCR proved
to be highly specific CT scan of head was abnormal in 56 out of
61 patients (91.8%). 12 (19.70%) were in stage I (meningeal
involvement only), 29 (47.50%) were in stage II (parenchymal
involvement only) and 15 (24.60%) were in stage III (both
parenchymal and meningeal invlolvement). The most common
finding in CT head was meningeal enhancement in 43 patients,
hydrocephalus in 37 patients and tuberculomas in 14 patients. The
most common sites of tuberculomas were frontal lobe (n=6;
42.8%), parietal lobe (n=4; 28.5%), followed by cerebellum in 2
patients and occipital in two. Nine patients had single and five
multiple tuberculomas. Of the 14 patients with tuberculomas,
hydrocephalus on CT was seen in 6 patients.
Conclusion: CT scan is a useful diagnostic tool even in very early
stages of TBM. Abnormalities reported on CT scan done are
hydrocephalus, infarcts, basal enhancement, and tuberculomas.
Normal study is reported in up to 20% of the cases.