Clinical characteristics, radiological pointers and outcomes of central nervous system tuberculosis

Background: Central nervous system tuberculosis (CNS-TB) is a severe and aggressive form of tuberculosis with a high mortality. With early identification and appropriate therapy, it carries a good outcome. Aim: To identify the clinical characteristics, radiological pointers, and outcomes of central nervous system tuberculosis. Methods: Single-center retrospective study was conducted from January 01, 2018 to December 31, 2022 on patients diagnosed with CNS-TB.Adult patients with at least nine months of follow-up were included. Those seropositive for HIV or lost to follow-up before treatment completion were excluded. Variables were expressed as mean with standard deviation, median, and range. Chi-square and student's t-test for qualitative and quantitative variables were used. Results: 158 records were reviewed, and 56 were excluded. 102 patients were included with 90(88.23 %) cases of tubercular meningitis(TBM) and 12 (11.76 %) cases of isolated tuberculoma. There were 22(24.44 %) and 63(70.00%) cases of definite and probable tuberculous meningitis. Leptomeningeal enhancement (79.41%)and hydrocephalus (42.22%)were noted commonly. All cases of TBM and tuberculoma completed 9–12 months of anti-tubercular treatment. Dexamethasone was given to all patients with TBM for 6–12 weeks. One patient with biopsy-proven isolated tuberculoma received up to 24 months of ATT. Nine patients with TBM died(9/102,8.82 %). Grade III TBM, age >60 years, hydrocephalus,drug-induced hepatitis, and extra-neural tuberculosis were significant in the expired versus survivors comparison (p < 0.05). Conclusions: Early identification, appropriate ATT regimen, and duration of treatment are associated with a good outcome in this fatal and disabling disease.