A complicated case of altered sensorium

Tuberculosis and malaria are two common diseases afflicting the population of the Indian subcontinent. Both are associated with fatal neurological complications. Clinically, it may be difficult to differentiate between the two, except for that the focal neurological complications are more common with central nervous system (CNS) tuberculosis than with cerebral malaria. We report the case of a 48-year-old woman who presented with a history of fever and altered sensorium of short duration. She was initially treated for falciparum malaria on the basis of positive peripheral smear and normal CT scan of the brain, but later on diagnosed to have CNS tuberculosis on the basis of persistence of symptoms, development of focal neurological symptoms and MRI of the brain showing multiple tuberculomas. She improved significantly with a course of antitubercular treatment (ATT) and systemic corticosteroids.