Abstract
Central nervous system tuberculosis is a serious infection, comprising approximately 10% of all cases of tuberculosis. It is a potentially curable disease, provided that the diagnosis is timely. Its clinical and radiological manifestations may mimic other infectious and non-infectious neurological conditions. Hence, familiarity with the imaging presentations of the various forms of central nervous system tuberculosis is essential to achieve an early diagnosis, thereby reducing the disease morbidity and mortality. This chapter reviews the imaging characteristics of the different forms of central nervous system tuberculosis involving the brain and the intradural component of the spine.
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Abbreviations
- AFB:
-
Acid-fast bacilli
- CNS:
-
Central nervous system
- CSF:
-
Cerebrospinal fluid
- CT:
-
Computed tomography
- DWI:
-
Diffusion-weighted imaging
- FLAIR:
-
Fluid-attenuated inversion recovery
- MRI:
-
Magnetic resonance imaging
- TB:
-
Tuberculosis
- TBA:
-
Tuberculous brain abscess
- TBM:
-
Tuberculous meningitis
References
Afghani B (1994) Paradoxical enlargement or development of intracranial tuberculomas during therapy: case report and review. Clin Infect Dis 19:1092–1099
Aggarwal A, Patra DP, Gupta K et al (2016) Dural tuberculoma mimicking meningioma: a clinicoradiologic review of dural en plaque lesions. World Neurosurg 88:686.e1
Ahluwalia VV, Dayananda Sagar G, Singh TP et al (2013) MRI spectrum of CNS tuberculosis. J Indian Acad Clin Med 14:83–90
Almeida A (2005) Tuberculosis of the spine and spinal cord. Eur J Radiol 55:193–201
Balériaux DL, Neugroschl C (2004) Spinal and spinal cord infection. Eur Radiol 14(Suppl. 3):E72–E83
Be NA, Kim KS, Bishai WR et al (2009) Pathogenesis of central nervous system tuberculosis. Curr Mol Med 9:94–99
Benson JC, Cervantes G, Baron TR et al (2018) Imaging features of neurotoxoplasmosis: a multiparametric approach, with emphasis on susceptibility-weighted imaging. Eur J Radiol Open 5:45–51
Bernaerts A, Vanhoenacker FM, Parizel PM et al (2003) Tuberculosis of the central nervous system: overview of neuroradiological findings. Eur Radiol 13:1876–1890
Changal K, Raina AH (2014) Central nervous system manifestations of tuberculosis: a review article. J Mycobac Dis 4:2. https://doi.org/10.4172/2161-1068.1000146
Chatterjee D, Radotra BD, Vasishta RK, Sharma K (2015) Vascular complications of tuberculous meningitis: an autopsy study. Neurol India 63:926–932
Chaudhary V, Bano S, Garga UC (2017) Central nervous system tuberculosis: an imaging perspective. Can Assoc Radiol J 68:1–10
Cherian A, Thomas SV (2011) Central nervous system tuberculosis. Afr Health Sci 11:116–127
Chin JH, Mateen FJ (2013) Central nervous system tuberculosis: challenges and advances in diagnosis and treatment. Curr Infect Dis Rep 15:631–635
Davis AG, Rohlwink UK, Proust A et al (2019) The pathogenesis of tuberculous meningitis. J Leukoc Biol 105:267–280
De Jong BC, Antonio M, Gagneux S (2010) Mycobacterium africanum—review of an important cause of human tuberculosis in West Africa. PLoS Negl Trop Dis 4:e744
Garg RK, Malhotra HS, Gupta R (2015) Spinal cord involvement in tuberculous meningitis. Spinal Cord 53:649–657
Garg RK, Malhotra HS, Jain A (2016) Neuroimaging in tuberculous meningitis. Neurol India 64:219–227
Goyal M, Sharma A, Mishra NK et al (1997) Imaging of pachymeningeal tuberculosis. AJR Am J Roentgenol 169:1421–1424
Gupta RK, Kumar S (2011) Central nervous system tuberculosis. Neuroimag Clin North Am 21:795–814
Gupta RK, Poptani H, Kohli A et al (1995) In vivo localized proton magnetic resonance spectroscopy of intracranial tuberculomas. Indian J Med Res 101:19–24
Gupta RK, Husain N, Kathuria MK et al (2001) Magnetization transfer MR imaging correlation with histopathology in intracranial tuberculomas. Clin Radiol 56:656–663
Jinkins JR, Gupta R, Chang KH (1995) MR imaging of central nervous system tuberculosis. Radiol Clin North Am 33:771–786
Khatri GD, Krishnan V, Antil N et al (2018) Magnetic resonance imaging spectrum of intracranial tubercular lesions: one disease, many faces. Pol J Radiol 83:524–535
Knobbe K, Gaines M (2020) Intramedullary tuberculoma of the spinal cord. Kans J Med 13:300–303
Ku BD (2009) Extensive meningeal and parenchymal calcified tuberculoma as long-term residual sequelae of tuberculous meningitis. Neurol India 57:521
Kumar R, Pandey CK, Bose N (2002) Tuberculous brain abscess: clinical presentation, pathophysiology and treatment (in children). Childs Nerv Syst 18:118–123
Lammie GA, Hewlett RH, Schoeman JF et al (2009) Tuberculous cerebrovascular disease: a review. J Infect 59:156–166
Leeds IL, Magee MJ, Kurbatova EV et al (2012) Site of extrapulmonary tuberculosis is associated with HIV infection. Clin Infect Dis 55:75–81
Liu J, Zhang H, He B et al (2016) Intramedullary tuberculoma combined with abscess: case report and literature review. World Neurosurg 89:726.e1–726.e4
Liu X, Rui M, Lyu L (2019) Tuberculous meningomyelitis in magnetic resonance imaging: a Chinese case report. Eur J Radiol Open 6:284–286
Lu M (2010) Imaging diagnosis of spinal intramedullary tuberculoma: case reports and literature review. J Spinal Cord Med 33:159–162
Marais S, Thwaites G, Johan F et al (2010) Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis 10:803–812
McGuinness FE (2000) Intracranial tuberculosis. In: Clinical imaging in non-pulmonary tuberculosis. Springer, Berlin Heidelberg, New York, pp 5–25
Menon S, Bharadwaj R, Chowdhary AS et al (2011) Tuberculous brain abscesses: case series and review of literature. J Neurosci Rural Pract 2:153–157
Momjian R, George M (2014) Atypical imaging features of tuberculous spondylitis: case report with literature review. J Radiol Case Rep 8(11):1–14
Nelson CA, Zunt JR (2011) Tuberculosis of the central nervous system in immunocompromised patients: HIV infection and solid organ transplant recipients. Clin Infect Dis 53:915–926
Ogul H, Ozkurt Z, Polat G (2017) Cerebral and spinal tuberculous leptomeningitis: advanced magnetic resonance imaging findings. J Craniofac Surg 28:477–478
Parmar H, Shah J, Patkar D et al (2000) Intramedullary tuberculomas. MR findings in seven patients. Acta Radiol 41:572–577
Parmar H, Sitoh Y, Anand P et al (2006) Contrast- enhanced flair imaging in the evaluation of infectious leptomeningeal diseases. Eur J Radiol 58:89–95
Patkar D, Narang J, Yanamandala R et al (2012) Central nervous system tuberculosis pathophysiology and imaging findings. Neuroimaging Clin North Am 22:677–705
Phypers M, Harris T, Power C (2006) CNS tuberculosis: a longitudinal analysis of epidemiological and clinical features. Int J Tuberc Lung Dis 10:99–103
Raza S, Sadaf A, Fecto F et al (2004) Patterns of tuberculosis in the central nervous system. Infect Dis J Pak 13:99–104
Rich AR, McCordock HA (1933) The pathogenesis of tuberculous meningitis. Bull Johns Hopkins Hosp 52:5–37
Robertson FC, Lepard JR, Mekary RA et al (2019) Epidemiology of central nervous system infectious diseases: a meta-analysis and systematic review with implications for neurosurgeons worldwide. J Neurosurg 130:1107–1126
Rock RB, Olin M, Baker CA et al (2008) Central nervous system tuberculosis: pathogenesis and clinical aspects. Clin Microbiol Rev 21:243–261
Salvador GLO, Basso ACN, Barbieri PP et al (2021) Central nervous system and spinal cord tuberculosis: revisiting an important disease. Clin Imaging 69:158–168
Sardana V, Shringi P (2020) Intramedullary tuberculoma of the spinal cord, clinical features and imaging: possibility of early diagnosis with imaging? Indian J Tuberc 67:346–348
Schaller MA, Wicke F, Foerch C et al (2019) Central nervous system tuberculosis: etiology, clinical manifestations and neuroradiological features. Clin Neuroradiol 29:3–18
Shah GV (2000) Central nervous system tuberculosis: imaging manifestations. Neuroimaging Clin North Am 10:355–374
Sharma MC, Arora R, Deol PS (2002) Intramedullary tuberculoma of the spinal cord: a series of 10 cases. Clin Neurol Neurosurg 104:279–284
Singh AK, Malhotra HS, Garg RK et al (2016) Paradoxical reaction in tuberculous meningitis: presentation, predictors and impact on prognosis. BMC Infect Dis 16:306
Taheri MS, Karimi MA, Haghighatkhah H (2015) Central nervous system tuberculosis: an imaging-focused review of a reemerging disease. Radiol Res Pract 2015:1–8
Thakur K, Das M, Dooley KE (2018) The global neurological burden of tuberculosis. Semin Neurol 38:226–237
Udani PM (1970) Tuberculous encephalopathy with and without meningitis clinical features and pathological correlations. J Neurol Sci 10:541–561
Vaishnav B, Suthar N, Shaikh S et al (2019) Clinical study of spinal tuberculosis presenting with neuro-deficits in Western India. Indian J Tuberc 66:81–86
Varghese P, Abdul Jalal M, Kandathil J (2017) Spinal intramedullary tuberculosis. Surg J (NY) 3:e53–e57
Verdon R, Chevret S, Laissy JP (1996) Tuberculous meningitis in adults: review of 48 cases. Clin Infect Dis 22:982–988
Wang GC, Wu SW (2017) Spinal intramedullary tuberculoma following pulmonary tuberculosis: a case report and literature review. Medicine 96:49
Whiteman ML (1997) Neuroimaging of central nervous system tuberculosis in HIV-infected patients. Neuroimaging Clin North Am 7:199–214
Wilkinson RJ, Rohlwink U, Misra UK et al (2017) Tuberculous meningitis. Nat Rev Neurol 13:581–598
World Health Organization (2019) Global tuberculosis report 2019. World Health Organization, Geneva. Available at: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-report-2019
World Health Organization (WHO) (2020) Global tuberculosis report 2020. World Health Organization, Geneva. Available at: https://apps.who.int/iris/bitstream/handle/10665/336069/9789240013131-eng.pdf
Yusuf A, Adeleke N, Babalola O et al (2015) Intramedullary tuberculoma of thoracic spinal cord in an apparently healthy Nigerian: case report. J West Afr Coll Surg 5:90–97
Zhang L, Zhang X, Li H et al (2019) Acute ischemic stroke in young adults with tuberculous meningitis. BMC Infect Dis 19:362
Zunt JR (2018) Tuberculosis of the central nervous system. Continuum (Minneap Minn) 24(5 Neuroinfectious Disease):1422–1438
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Hammami, N. et al. (2022). Imaging of Central Nervous System Tuberculosis. In: Ladeb, M.F., Peh, W.C.G. (eds) Imaging of Tuberculosis. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/978-3-031-07040-2_5
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