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. 2014 Jun;4(3):199-205.
doi: 10.1212/CPJ.0000000000000023.

Tuberculous meningitis: Diagnostic and therapeutic challenges

Jerome H Chin  1
Affiliations

Tuberculous meningitis: Diagnostic and therapeutic challenges

Jerome H Chin. Neurol Clin Pract. 2014 Jun.

Abstract

Neurologists are often the first medical providers to evaluate patients with possible infectious meningitis. Knowledge of the clinical presentations and cerebrospinal fluid, microbiologic, and neuroimaging findings for different etiologies is essential to make a prompt diagnosis and initiate appropriate treatment. Tuberculosis is a common cause of meningitis in developing countries with a high prevalence of pulmonary tuberculosis. However, tuberculosis affects populations in every country and all neurologists need to be vigilant for possible cases of tuberculous meningitis presenting to their medical facilities. This article discusses the challenges of diagnosing and treating tuberculous meningitis and highlights recent advances in diagnostic technology.

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Figures

Figure 1
Figure 1. Chest X-ray of pulmonary tuberculosis
Bilateral infiltrates and hilar adenopathy suggestive of active tuberculosis.
Figure 2
Figure 2. Xpert MTB/RIF nucleic acid amplification test
Xpert MTB/RIF results on the CSF of a 53-year-old patient with tuberculous meningitis and HIV coinfection. Ziehl-Neelsen stain of CSF for acid-fast bacilli was negative.
Figure 3
Figure 3. Neuroimaging in tuberculous meningitis
(A) Brain CT of a 19-year-old patient with tuberculous meningitis (TBM) shows hydrocephalus and basal meningeal enhancement. (B) Brain MRI of a 56-year-old patient with TBM shows basal ganglia infarcts.
See this image and copyright information in PMC

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