Brain Tuberculosis: An Odyssey through Time to Understand This Pathology

Abstract

Tuberculosis is a contagious disease that has been a concern for humanity throughout history, being recognized and referred to as the white plague. Since ancient times, starting with Hippocrates and Galen of Pergamon, doctors and scientists have attempted to understand the pathogenesis of tuberculosis and its manifestations in the brain. If, in the medieval period, it was believed that only the touch of a king could cure the disease, it was only in the early 17th and 18th centuries that the first descriptions of tuberculous meningitis and the first clinico-pathological correlations began to emerge. While the understanding of neurotuberculosis progressed slowly, it was only after the discovery of the pathogenic agent in the late 19th century that there was an upward curve in the occurrence of treatment methods. This review aims to embark on an odyssey through the centuries, from ancient Egypt to the modern era, and explore the key moments that have contributed to the emergence of a new era of hope in the history of neurotuberculosis. Understanding the history of treatment methods against this disease, from empirical and primitive ones to the emergence of new drugs used in multi-drug-resistant tuberculosis, leads us, once again, to realize the significant contribution of science and medicine in treating a disease that was considered incurable not long ago.

Keywords: CNS tuberculosis; brain tuberculosis; meningitis; neurotuberculosis; tubercle bacillus.

Figure 1

(A) Image from the tomb of the building master Ipwy (19th dynasty, Deir el-Medina) which depicts a gardener with spine tuberculosis (with possible Pott’s disease) (public domain). (B) A 15th century image representing King Clovis I touching for scrofula (public domain).

Figure 2

(A) Portrait of Richard Morton (1637–1698) represented in his book. (B) The title page of his book Phthisiologia: or, a Treatise of Consumptions, printed for W. And J. Innys, London (1720) (public domain).

Figure 3

(A) Portrait of Robert Whytt (1714–1766). (B) The title page of his work Observations on the Dropsy in the Brain, printed for John Balfour by Balfour, Auld & Smelie, Edinburgh (1768). (C) Original description of the first stage and (D) the second stage of tuberculous meningitis (first pages) (public domain).

Figure 4

(A) Portrait of Robert Hooper (c. 1770/1772) by John Singleton Copley (1738–1815), Smithsonian American Art Museum. (B) Illustration of a purulent basilar meningitis in his atlas The Morbid Anatomy of the Human Brain (1826) by Robert Hooper: “Plate IV. INFLAMMATION OF THE PIA MATER and TUNICA ARACHNOIDES: The cerebrum and cerebellum so placed as to bring the whole of the base or under surface of the brain into view. The same diseases appearances are seen in this as in the former plate, but to a much greater extent: a puriform albumen is secreted on the surface of the lobes of the cerebrum, on that of the cerebellum, and over the whole of the medulla oblongata” (public domain).

Figure 5

“Laënnec à l’hôpital Necker ausculte un phtisique devant ses élèves” (Laënnec examines a consumptive patient with a stethoscope in front of his students at the Necker Hospital), painting by Théobald Chartran (1816) (public domain).

Figure 6

(A) Portrait of Professor Robert Koch (1843–1910), published in 1907 in Les Prix Nobel. (B) Koch’s drawing of tuberculosis bacilli in 1882 (from Die Ätiologie der Tuberkulose) (public domain).

Figure 7

(A) Photograph of William Macewen (c. 1910). (B) The title page of his book, Pyogenic Disease of the Brain and Spinal Cord. Meningitis, Abscesses of the Brain, Infective Sinus Thrombosis (1893). (C) Figure 37 from his book: “Abscess in left temporo-sphenoidal lobe. Aperture in base of brain, connected with abscess in temporo-sphenoidal lobe, and with granulation mass springing from the membranes and causing an indentation on cerebral surface. The tegment antri and tympani were eroded. From photograph” (public domain).

Figure 8

Cases of acute sub-periosteal squamo-mastoid abscesses, presented in the book Pyogenic Disease of the Brain and Spinal Cord. Meningitis, Abscesses of the Brain, Infective Sinus Thrombosis. (A) “Front view appearances presented in acute sub-periosteal squamo-mastoid abcess. The forward displacement of the ear is well illustrated (Case V)”. (B) “Appearance presented in acute sub-periosteal squamo-mastoid abscess of large size (case VI)” (public domain).