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Nervous system tuberculosis is the most dangerous form of tuberculosis, usually with severe course and high mortality. Fortunately - very rare in Poland. What are the symptoms of tuberculosis of the nervous system? What is the diagnosis of the disease?

Nervous system tuberculosisis one of the types of tuberculosis - the disease is caused by mycobacteria ( Mycobacterium tuberculosis ), called Koch mycobacteria. These bacteria usually attack the lungs, but sometimes also the central nervous system, the circulatory system, the lymphatic system, the osteoarticular system, the genitourinary system, as well as the skin, spleen, liver and other organs. These are extremely dangerous microorganisms, difficult to fight due to high resistance to many environmental factors, such as: very high or very low temperature, high or low pH, drying. Nervous system tuberculosis is the most severe form of tuberculosis with a high mortality rate.

What is tuberculosis of the nervous system

We talk about this form of the disease when pathogenic mycobacteria enter the brain and spinal cord, where they form subcortical or on the meninges inflammatory foci (Rich's outbreaks) - nodules (hence the name). The most common form of this disease is tuberculous meningitis. Occasionally, intracranial tuberculomas and tuberculosis of the spinal cord develop.

1. Tuberculous meningitis

This type of tuberculosis begins when the content of the tuberculosis enters the subarachnoid space. It can happen weeks to years after infection. This is where inflammation develops, the strongest based on the brain. There, a thick, gelatinous exudate begins to accumulate. The inflammatory reaction damages the cranial nerves and inhibits the circulation of the cerebrospinal fluid (leading to hydrocephalus). It also affects blood vessels leading to a cerebral infarction. The first symptoms appear 2-8 weeks after infection.

  • Symptoms of tuberculous meningitis

Usually the sick person is taken to the hospital when he is already unconscious. It rarely reacts earlier, because the symptoms are ambiguous, they may indicate many other ailments. Initial symptoms:

  • elevated temperature
  • sleepiness
  • apathy or excessivearousal
  • headaches
  • nausea, vomiting

Over time, these appear:

  • neck stiffness
  • convulsions (especially in children)
  • double vision, photophobia
  • speech disorder
  • paresis of limbs
  • disturbance of consciousness
Important

Tuberculous meningitis develops faster in children. A characteristic symptom of the disease in young patients is the so-called post-cerebral stiffness. They also complain of abdominal pain more often - in adults, in the first phase, headache is the dominant one.

  • Diagnosis and treatment of tuberculous meningitis

    • First of all, it should be emphasized that the diagnosis of extrapulmonary tuberculosis is more difficult than in the case of pulmonary tuberculosis. This extrapulmonary form of the disease can be suspected in patients with:

  • chronic inflammation of the lymph nodes
  • exudative pleurisy or peritonitis where the fluid is rich in lymphocytes and its culture is negative
  • inflammation of a single joint with negative bacteriological test results
  • chronic pyuria
  • pericardial effusion of unknown origin
  • osteomyelitis with vertebrae involvement of the thoracic spine
  • CSF changes with high lymphocyte counts, elevated protein levels, and lowered glucose levels

    • Extrapulmonary tuberculosis is mostly secondary to pulmonary tuberculosis. Therefore, the basic diagnostic examination is chest X-ray and magnetic resonance imaging. In half of adults and most children, they show the changes brought about by tuberculosis. Tuberkpin test is also performed, but a negative result does not rule out tuberculosis. An eye fundus examination is also recommended, thanks to which it is possible to locate tuberculous nodules. You also need to perform a CSF collection.

    Tuberculous meningitis: prognosis

    Untreated TB meningitis always leads to death. To prevent this from happening, when the infection is suspected (without waiting for the test results), antituberculosis drugs are administered, because time plays a decisive role. These drugs include: isoniazid (INH), rifampicin (RMP), pyrazinamide (PZA) and streptomycin (SM). In more advanced stages of the disease, glucocorticosteroids (prednisone or dexamethasone) are added, and sometimes surgery is also performed to reduce hydrocephalus. As for the prognosis, it all depends on the stage of the disease under treatment and the severity of the disorder.awareness. The prognosis is usually worse in children and the elderly. Mortality in unconscious patients is 50-70%. Half of the cured people still have permanent damage to the nervous system. The remnants of tuberculosis can be memory loss, dementia, hydrocephalus, epilepsy, blindness, deafness, and paralysis of the cranial nerves. A complication of TB meningitis in childhood is also an impairment of the intellect.

    Important

    Tuberculosis is an infectious disease transmitted by airborne droplets. It most commonly affects the lungs, but can also affect any other organ. In the first stage, mycobacteria enter the respiratory system - they travel to the alveoli, where they begin to multiply. From there, through the blood, they can get on.

    2. Intracranial tuberculomas

    Intracranial tuberculomas can occur separately or together with tuberculous meningitis. Tuberculomas are formed from intracranial nodules that have grown in size but have not ruptured into the subarachnoid space. Symptoms depend on the size and location of the tuberculomas and the pressure they exert on adjacent structures. They can be:

    • headaches
    • convulsions
    • paresis
    • personality changes
    • Tuberculosis diagnosis and treatment

    If meningitis is not present at the same time as tuberculosis, the cerebrospinal fluid may be normal. Magnetic resonance imaging and computed tomography are used to detect tuberculomas. It should be added that tuberculomas do not differ in appearance from neoplastic tumors. Therefore, for diagnosis, it is necessary to perform a biopsy (after surgical removal of the lesion). Tuberculomas are treated with isoniazid and rifampicin for two years.

    3. Spinal tuberculosis

    A very rare form of tuberculosis of the nervous system. Symptoms include:

    • root pains
    • paresthesias
    • electrocution
    • bladder dysfunction
    • muscle atrophy.

    Treatment similar to that described above.

    Worth knowing

    In 2005, 81% of all TB cases in Europe were pulmonary tuberculosis. The rest were cases of extrapulmonary tuberculosis, including the nervous system. In the same year in Poland, extrapulmonary tuberculosis affected only 8.8% of tuberculosis patients. This discrepancy may result from both incomplete registration of all illnesses and deficiencies in diagnostics. However, the overall trend for tuberculosis cases is declining. This disease is a problem mainly in developing countries in Southeast Asia, Equatorial Africa.It is also worth adding that the infection remains 90% asymptomatic. Of those infected, no more than 10% will become ill, but the risk of contracting the disease is life-long.

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    Category:

    Neurology