Skip to main content

Advertisement

SpringerLink
Log in

Central Nervous System Tuberculosis

Etiology, Clinical Manifestations and Neuroradiological Features

  • Review Article
  • Published:
Clinical Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

As a result of multilateral migration and globalization in times of humanitarian crises, western countries face a possible increase in the incidence of central nervous system tuberculosis (CNS TB). The diagnosis of CNS TB is challenging and often delayed due to the manifold and often non-specific presentation of the disease. The aim of this review is to analyze and summarize imaging features and correlated clinical findings of CNS TB.

Methods

The different manifestations of CNS TB are explained and illustrated by characteristic neuroradiological as well as neuropathological findings. An overview on diagnostic and therapeutic approaches is provided. For clarity, tables summarizing the lesion patterns, differential diagnoses and diagnostic hints are added.

Results

The CNS TB can be manifested (1) diffuse as tuberculous meningitis (TBM), (2) localized as tuberculoma or (3) tuberculous abscess or (4) in extradural and intradural spinal infections. Information on clinical presentation, underlying pathology and the distinguishing features is demonstrated. The TBM is further described, which may lead to cranial nerve palsy, hydrocephalus and infarction due to associated arteritis of the basal perforators. The differential diagnoses are vast and include other infections, such as bacterial, viral or fungal meningoencephalitis, malignant causes or systemic inflammation with CNS. Complicating factors of diagnosis and treatment are HIV coinfection, multi-drug resistance and TB-associated immune reconstitution inflammatory syndrome (IRIS).

Conclusions

Neurologists and (neuro-)radiologists should be familiar with the neuroradiological presentation and the clinical course of CNS TB to ensure timely diagnosis and treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14

Similar content being viewed by others

References

  1. World Health Organization. Global tuberculosis report 2016. Geneva: WHO; 2016.

    Google Scholar 

  2. Raviglione MC, Snider DE Jr, Kochi A. Global epidemiology of tuberculosis. Morbidity and mortality of a worldwide epidemic. JAMA. 1995;273:220–6.

    Article  CAS  PubMed  Google Scholar 

  3. Bernaerts A, Vanhoenacker FM, Parizel PM, Van Goethem JW, Van Altena R, Laridon A, De Roeck J, Coeman V, De Schepper AM. Tuberculosis of the central nervous system: overview of neuroradiological findings. Eur Radiol. 2003;13:1876–90.

    Article  CAS  PubMed  Google Scholar 

  4. World Health Organization. Global tuberculosis control: surveillance, planning, financing. Geneva: WHO; 2004.

    Google Scholar 

  5. Verdon R, Chevret S, Laissy JP, Wolff M. Tuberculous meningitis in adults: review of 48 cases. Clin Infect Dis. 1996;22:982–8.

    Article  CAS  PubMed  Google Scholar 

  6. Wilkinson RJ, Rohlwink U, Misra UK, van Crevel R, Mai NTH, Dooley KE, Caws M, Figaji A, Savic R, Solomons R, Thwaites GE; Tuberculous Meningitis International Research Consortium. Tuberculous meningitis. Nat Rev Neurol. 2017;13:581–98.

    Article  PubMed  Google Scholar 

  7. Rock RB, Olin M, Baker CA, Molitor TW, Peterson PK. Central nervous system tuberculosis: pathogenesis and clinical aspects. Clin Microbiol Rev. 2008;21:243–61. table of contents.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR. Epidemiology of extrapulmonary tuberculosis in the United States, 1993–2006. Clin Infect Dis. 2009;49:1350–7.

    Article  PubMed  Google Scholar 

  9. El Sahly HM, Teeter LD, Pan X, Musser JM, Graviss EA. Mortality associated with central nervous system tuberculosis. J Infect. 2007;55:502–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kennedy DH, Fallon RJ. Tuberculous meningitis. JAMA. 1979;241:264–8.

    Article  CAS  PubMed  Google Scholar 

  11. Thwaites GE, Schoeman JF. Update on tuberculosis of the central nervous system: pathogenesis, diagnosis, and treatment. Clin Chest Med. 2009;30:745–54.

    Article  PubMed  Google Scholar 

  12. Department of Health. Reported tuberculosis in the United States, 2013. 2014.

    Google Scholar 

  13. Phypers M, Harris T, Power C. CNS tuberculosis: a longitudinal analysis of epidemiological and clinical features. Int J Tuberc Lung Dis. 2006;10:99–103.

    CAS  PubMed  Google Scholar 

  14. Hoşoğlu S, Geyik MF, Balik I, Aygen B, Erol S, Aygencel SG, Mert A, Saltoğlu N, Dökmetaş I, Felek S, Sünbül M, Irmak H, Aydin K, Ayaz C, Kökoğlu OF, Uçmak H, Satilmiş S. Tuberculous meningitis in adults in Turkey: epidemiology, diagnosis, clinic and laboratory [corrected]. Eur J Epidemiol. 2003;18:337-43.

    Article  PubMed  Google Scholar 

  15. Arvanitakis Z, Long RL, Hershfield ES, Manfreda J, Kabani A, Kunimoto D, Power C. M. tuberculosis molecular variation in CNS infection: evidence for strain-dependent neurovirulence. Neurology. 1998;50:1827–32.

    Article  CAS  PubMed  Google Scholar 

  16. Bishburg E, Sunderam G, Reichman LB, Kapila R. Central nervous system tuberculosis with the acquired immunodeficiency syndrome and its related complex. Ann Intern Med. 1986;105:210–3.

    Article  CAS  PubMed  Google Scholar 

  17. Thwaites GE, Tran TH. Tuberculous meningitis: many questions, too few answers. Lancet Neurol. 2005;4:160–70.

    Article  PubMed  Google Scholar 

  18. Lesprit P, Zagdanski AM, de La Blanchardière A, Rouveau M, Decazes JM, Frija J, Lagrange P, Modaï J, Molina JM. Cerebral tuberculosis in patients with the acquired immunodeficiency syndrome (AIDS). Report of 6 cases and review. Medicine (Baltimore). 1997;76:423–31.

    Article  CAS  Google Scholar 

  19. Askling J, Fored CM, Brandt L, Baecklund E, Bertilsson L, Cöster L, Geborek P, Jacobsson LT, Lindblad S, Lysholm J, Rantapää-Dahlqvist S, Saxne T, Romanus V, Klareskog L, Feltelius N. Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden. Arthritis Rheum. 2005;52:1986–92.

    Article  CAS  PubMed  Google Scholar 

  20. Mackert BM, Conradi J, Loddenkemper C, van Landeghem FK, Loddenkemper R, Ignatius R, Schneider T. Neurotuberculosis: a continuing clinical challenge. Nervenarzt. 2008;79:153–66.

    Article  PubMed  Google Scholar 

  21. Berenguer J, Moreno S, Laguna F, Vicente T, Adrados M, Ortega A, González-LaHoz J, Bouza E. Tuberculous meningitis in patients infected with the human Immunodeficiency virus. N Engl J Med. 1992;326:668–72.

    Article  CAS  PubMed  Google Scholar 

  22. Ducomble T, Tolksdorf K, Karagiannis I, Hauer B, Brodhun B, Haas W, Fiebig L. The burden of extrapulmonary and meningitis tuberculosis: an investigation of national surveillance data, Germany, 2002 to 2009. Euro Surveill. 2013;18(12):20436.

    PubMed  Google Scholar 

  23. Keane J. TNF-blocking agents and tuberculosis: new drugs illuminate an old topic. Rheumatology. 2005;44:714–20.

    Article  CAS  PubMed  Google Scholar 

  24. Chin JH. Tuberculous meningitis: diagnostic and therapeutic challenges. Neurol Clin Pract. 2014;4:199–205.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Dastur DK, Manghani DK, Udani PM. Pathology and pathogenetic mechanisms in neurotuberculosis. Radiol Clin North Am. 1995;33:733–52.

    CAS  PubMed  Google Scholar 

  26. Rom WN, Garay SM. Tuberculosis. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2004.

    Google Scholar 

  27. Rich A, McCordock H. The pathogenesis of tuberculous meningitis. Bull Johns Hopkins Hosp. 1933;52:5–37.

    Google Scholar 

  28. Ropper AH, Samuels MA, Klein JP. Adams and Victor’s Principles of Neurology. 10th ed. New York: McGraw-Hill; 2014.

    Google Scholar 

  29. Kumar R, Pandey CK, Bose N, Sahay S. Tuberculous brain abscess: clinical presentation, pathophysiology and treatment (in children). Childs Nerv Syst. 2002;18:118–23.

    Article  PubMed  Google Scholar 

  30. Garcia-Monco JC. Tuberculosis. In: Biller J, Ferro J, editors. Handb Clin Neurol. Neurol Asp Syst Dis Part III. 3rd Series, Vol. 121. Amsterdam: Elsevier; 2014.

    Google Scholar 

  31. Bidstrup C, Andersen PH, Skinhøj P, Andersen AB. Tuberculous meningitis in a country with a low incidence of tuberculosis: still a serious disease and a diagnostic challenge. Scand J Infect Dis. 2002;34:811–4.

    Article  PubMed  Google Scholar 

  32. Andronikou S, Smith B, Hatherhill M, Douis H, Wilmshurst J. Definitive neuroradiological diagnostic features of tuberculous meningitis in children. Pediatr Radiol. 2004;34:876–85.

    Article  PubMed  Google Scholar 

  33. Thwaites G, Fisher M, Hemingway C, Scott G, Solomon T, Innes J; British Infection Society. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect. 2009;59:167–87.

    Article  PubMed  Google Scholar 

  34. Sütlaş PN, Unal A, Forta H, Senol S, Kirbaş D. Tuberculous meningitis in adults: review of 61 cases. Infection. 2003;31:387–91.

    PubMed  Google Scholar 

  35. Hopewell PC. A clinical view of tuberculosis. Radiol Clin North Am. 1995;33:641–53.

    CAS  PubMed  Google Scholar 

  36. al-Deeb SM, Yaqub BA, Sharif HS, Motaery KR. Neurotuberculosis: a review. Clin Neurol Neurosurg. 1992;94(Suppl):S30–S3.

    Article  PubMed  Google Scholar 

  37. Thwaites GE, van Toorn R, Schoeman J. Tuberculous meningitis: more questions, still too few answers. Lancet Neurol. 2013;12:999–1010.

    Article  CAS  PubMed  Google Scholar 

  38. Dalal PM. Observations on the involvement of cerebral vessels in tuberculous meningitis in adults. Adv Neurol. 1979;25:149–59.

    CAS  PubMed  Google Scholar 

  39. Udani PM, Parekh UC, Dastur DK. Neurological and related syndromes in CNS tuberculosis. Clinical features and pathogenesis. J Neurol Sci. 1971;14:341–57.

    Article  CAS  PubMed  Google Scholar 

  40. Smith HV. Tuberculous meningitis. Int J Neurol. 1964;4(V):134–57.

    CAS  PubMed  Google Scholar 

  41. Lammie GA, Hewlett RH, Schoeman JF, Donald PR. Tuberculous cerebrovascular disease: a review. J Infect. 2009;59:156–66.

    Article  PubMed  Google Scholar 

  42. Misra UK, Kalita J, Bhoi SK, Singh RK. A study of hyponatremia in tuberculous meningitis. J Neurol Sci. 2016;367:152–7.

    Article  CAS  PubMed  Google Scholar 

  43. Jeren T, Beus I. Characteristics of cerebrospinal fluid in tuberculous meningitis. Acta Cytol. 1982;26:678–80.

    CAS  PubMed  Google Scholar 

  44. Cho TY, Park SC, Cho SN, Lee HR, Kim SK, Kim SK, Lee BI. Intrathecal synthesis of immunoglobulin G and Mycobacterium tuberculosis-specific humoral immune response in tuberculous meningitis. Clin Diagn Lab Immunol. 1995;2:361–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Thwaites GE, Chau TT, Stepniewska K, Phu NH, Chuong LV, Sinh DX, White NJ, Parry CM, Farrar JJ. Diagnosis of adult tuberculous meningitis by use of clinical and laboratory features. Lancet. 2002;360:1287–92.

    Article  CAS  PubMed  Google Scholar 

  46. Moghtaderi A, Alavi-Naini R, Izadi S, Cuevas LE. Diagnostic risk factors to differentiate tuberculous and acute bacterial meningitis. Scand J Infect Dis. 2009;41:188–94.

    Article  PubMed  Google Scholar 

  47. Kumar R, Jain R, Kaur A, Chhabra DK. Brain stem tuberculosis in children. Br J Neurosurg. 2000;14:356–61.

    Article  CAS  PubMed  Google Scholar 

  48. Thwaites GE, Duc Bang N, Huy Dung N, Thi Quy H, Thi Tuong Oanh D, Thi Cam Thoa N, Quang Hien N, Tri Thuc N, Ngoc Hai N, Thi Ngoc Lan N, Ngoc Lan N, Hong Duc N, Ngoc Tuan V, Huu Hiep C, Thi Hong Chau T, Phuong Mai P, Thi Dung N, Stepniewska K, Simmons CP, White NJ, Tinh Hien T, Farrar JJ. The influence of HIV infection on clinical presentation, response to treatment, and outcome in adults with Tuberculous meningitis. J Infect Dis. 2005;192:2134–41.

    Article  PubMed  Google Scholar 

  49. Yaramiş A, Gurkan F, Elevli M, Söker M, Haspolat K, Kirbaş G, Taş MA. Central nervous system tuberculosis in children: a review of 214 cases. Pediatrics. 1998;102:E49.

    Article  PubMed  Google Scholar 

  50. Offenbacher H, Fazekas F, Schmidt R, Kleinert R, Payer F, Kleinert G, Lechner H. MRI in tuberculous meningoencephalitis: report of four cases and review of the neuroimaging literature. J Neurol. 1991;238:340–4.

    Article  CAS  PubMed  Google Scholar 

  51. Tartaglione T, Di Lella GM, Cerase A, Leone A, Moschini M, Colosimo C. Diagnostic imaging of neurotuberculosis. Rays. 1998;23:164–80.

    CAS  PubMed  Google Scholar 

  52. Schoeman J, Hewlett R, Donald P. MR of childhood tuberculous meningitis. Neuroradiology. 1988;30:473–7.

    Article  CAS  PubMed  Google Scholar 

  53. Kioumehr F, Dadsetan MR, Rooholamini SA, Au A. Central nervous system tuberculosis: MRI. Neuroradiology. 1994;36:93–6.

    Article  CAS  PubMed  Google Scholar 

  54. Jinkins JR, Gupta R, Chang KH, Rodriguez-Carbajal J. MR imaging of central nervous system tuberculosis. Radiol Clin North Am. 1995;33:771–86.

    CAS  PubMed  Google Scholar 

  55. McGuinness FE. Tuberculous radiculomyelopathy and myelitic tuberculomas. In: Clin Imaging Non-Pulmonary Tuberc. Berlin Heidelberg New York: Springer; 2000. pp. 27–42.

    Chapter  Google Scholar 

  56. Garg R, Malhotra H, Jain A. Neuroimaging in tuberculous meningitis. Neurol India. 2016;64:219.

    Article  PubMed  Google Scholar 

  57. Bhargava S, Gupta AK, Tandon PN. Tuberculous meningitis—a CT study. Br J Radiol. 1982;55:189–96.

    Article  CAS  PubMed  Google Scholar 

  58. Ozateş M, Kemaloglu S, Gürkan F, Ozkan U, Hoşoglu S, Simşek MM. CT of the brain in tuberculous meningitis. A review of 289 patients. Acta Radiol. 2000;41:13–7.

    Article  PubMed  Google Scholar 

  59. Uysal G, Köse G, Güven A, Diren B. Magnetic resonance imaging in diagnosis of childhood central nervous system tuberculosis. Infection. 2001;29:148–53.

    Article  CAS  PubMed  Google Scholar 

  60. Botha H, Ackerman C, Candy S, Carr JA, Griffith-Richards S, Bateman KJ. Reliability and diagnostic performance of CT imaging criteria in the diagnosis of tuberculous meningitis. PLoS ONE. 2012;7:e38982.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Bullock MR, Welchman JM. Diagnostic and prognostic features of tuberculous meningitis on CT scanning. J Neurol Neurosurg Psychiatr. 1982;45:1098–101.

    Article  CAS  Google Scholar 

  62. Parmar H, Sitoh Y‑Y, Anand P, Chua V, Hui F. Contrast-enhanced flair imaging in the evaluation of infectious leptomeningeal diseases. Eur J Radiol. 2006;58:89–95.

    Article  PubMed  Google Scholar 

  63. Given CA 2nd, Burdette JH, Elster AD, Williams DW 3rd. Pseudo-subarachnoid hemorrhage: a potential imaging pitfall associated with diffuse cerebral edema. AJNR Am J Neuroradiol. 2003;24:254–6.

    PubMed  Google Scholar 

  64. Raut T, Garg RK, Jain A, Verma R, Singh MK, Malhotra HS, Kohli N, Parihar A. Hydrocephalus in tuberculous meningitis: Incidence, its predictive factors and impact on the prognosis. J Infect. 2013;66:330–7.

    Article  PubMed  Google Scholar 

  65. Donald PR, Schoeman JF. Tuberculous meningitis. N Engl J Med. 2004;351:1719–20.

    Article  CAS  PubMed  Google Scholar 

  66. Shukla R, Abbas A, Kumar P, Gupta RK, Jha S, Prasad KN. Evaluation of cerebral infarction in tuberculous meningitis by diffusion weighted imaging. J Infect. 2008;57:298–306.

    Article  PubMed  Google Scholar 

  67. Misra UK, Kalita J, Maurya PK. Stroke in tuberculous meningitis. J Neurol Sci. 2011;303:22–30.

    Article  PubMed  Google Scholar 

  68. Mathew NT, Abraham J, Chandy J. Cerebral angiographic features in tuberculous meningitis. Neurology. 1970;20:1015–23.

    Article  CAS  PubMed  Google Scholar 

  69. Kalita J, Misra UK, Nair PP. Predictors of stroke and its significance in the outcome of tuberculous meningitis. J Stroke Cerebrovasc Dis. 2009;18:251–8.

    Article  PubMed  Google Scholar 

  70. Schaberg T, Bauer T, Castell S, Dalhoff K, Detjen A, Diel R, Greinert U, Hauer B, Lange C, Magdorf K, Loddenkemper R. Empfehlungen zur Therapie, Chemoprävention und Chemoprophylaxe der Tuberkulose im Erwachsenen- und Kindesalter. Pneumologie. 2012;66:133–71.

    Article  CAS  PubMed  Google Scholar 

  71. Donald PR. Cerebrospinal fluid concentrations of antituberculosis agents in adults and children. Tuberculosis. 2010;90:279–92.

    Article  CAS  PubMed  Google Scholar 

  72. World Health Organization. Treatment of tuberculosis: guidelines. Treat. Tuberc. Guidel. Geneva: World Health Organization; 2010.

    Google Scholar 

  73. Thwaites GE, Nguyen DB, Nguyen HD, Hoang TQ, Do TT, Nguyen TC, Nguyen QH, Nguyen TT, Nguyen NH, Nguyen TN, Nguyen NL, Nguyen HD, Vu NT, Cao HH, Tran TH, Pham PM, Nguyen TD, Stepniewska K, White NJ, Tran TH, Farrar JJ. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. N Engl J Med. 2004;351:1741–51.

    Article  CAS  PubMed  Google Scholar 

  74. Thwaites GE, Macmullen-Price J, Tran TH, Pham PM, Nguyen TD, Simmons CP, White NJ, Tran TH, Summers D, Farrar JJ. Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study. Lancet Neurol. 2007;6:230–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  75. Prasad K, Singh MB, Ryan H. Corticosteroids for managing tuberculous meningitis. Cochrane Database Syst Rev. 2008; https://doi.org/10.1002/14651858.CD002244.pub4.

    Article  PubMed  Google Scholar 

  76. Peterson PK, Gekker G, Hu S, Sheng WS, Anderson WR, Ulevitch RJ, Tobias PS, Gustafson KV, Molitor TW, Chao CC. CD14 receptor-mediated uptake of nonopsonized Mycobacterium tuberculosis by human microglia. Infect Immun. 1995;63:1598–602.

    CAS  PubMed  PubMed Central  Google Scholar 

  77. Burn CG, Finley KH. The role of hypersensitivity in the production of experimental meningitis: I. Experimental meningitis in tuberculous animals. J Exp Med. 1932;56:203–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Pepper DJ, Marais S, Maartens G, Rebe K, Morroni C, Rangaka MX, Oni T, Wilkinson RJ, Meintjes G. Neurologic manifestations of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome: a case series. Clin Infect Dis. 2009;48:e96–107.

    Article  PubMed  Google Scholar 

  79. Marais S, Pepper DJ, Marais BJ, Török ME. HIV-associated tuberculous meningitis—diagnostic and therapeutic challenges. Tuberculosis (Edinb). 2010;90:367–74.

    Article  Google Scholar 

  80. Kalita J, Prasad S, Misra UK. Predictors of paradoxical tuberculoma in tuberculous meningitis. Int J Tuberc Lung Dis. 2014;18:486–91.

    Article  CAS  PubMed  Google Scholar 

  81. Török ME. Tuberculous meningitis: advances in diagnosis and treatment. Br Med Bull. 2015;113:117–31.

    Article  CAS  PubMed  Google Scholar 

  82. Schaberg T, Forssbohm M, Hauer B, Kirsten D, Kropp R, Loddenkemper R, Magdorf K, Rieder H, Sagebiel D, Urbanczik R. Guidelines for drug treatment of tuberculosis in adults and childhood. Pneumologie. 2001;55:494–511.

    Article  CAS  PubMed  Google Scholar 

  83. Abdool Karim SS, Naidoo K, Grobler A, Padayatchi N, Baxter C, Gray A, Gengiah T, Nair G, Bamber S, Singh A, Khan M, Pienaar J, El-Sadr W, Friedland G, Abdool Karim Q. Timing of initiation of antiretroviral drugs during tuberculosis therapy. N Engl J Med. 2010;362:697–706.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. World Health Organization. Department of HIV/AIDS. Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach: 2010 revision. Geneva: World Health Organization; 2010.

    Google Scholar 

  85. DeLance AR, Safaee M, Oh MC, Clark AJ, Kaur G, Sun MZ, Bollen AW, Phillips JJ, Parsa AT. Tuberculoma of the central nervous system. J Clin Neurosci. 2013;20:1333–41.

    Article  PubMed  Google Scholar 

  86. Kim TK, Chang KH, Kim CJ, Goo JM, Kook MC, Han MH. Intracranial tuberculoma: comparison of MR with pathologic findings. AJNR Am J Neuroradiol. 1995;16:1903–8.

    CAS  PubMed  Google Scholar 

  87. Wasay M, Kheleani BA, Moolani MK, Zaheer J, Pui M, Hasan S, Muzaffar S, Bakshi R, Sarawari AR. Brain CT and MRI findings in 100 consecutive patients with intracranial tuberculoma. J Neuroimaging. 2003;13:240–7.

    Article  PubMed  Google Scholar 

  88. Bargalló J, Berenguer J, García-Barrionuevo J, Ubeda B, Bargalló N, Cardenal C, Mercader JM. The “target sign”: is it a specific sign of CNS tuberculoma? Neuroradiology. 1996;38:547–50.

    Article  PubMed  Google Scholar 

  89. Chakraborti S, Mahadevan A, Govindan A, Nagarathna S, Santosh V, Yasha TC, Devi BI, Chandramouli BA, Kovoor JM, Chandramuki A, Shankar SK. Clinicopathological study of tuberculous brain abscess. Pathol Res Pract. 2009;205:815–22.

    Article  PubMed  Google Scholar 

  90. Luthra G, Parihar A, Nath K, Jaiswal S, Prasad KN, Husain N, Husain M, Singh S, Behari S, Gupta RK. Comparative evaluation of fungal, tubercular, and pyogenic brain abscesses with conventional and diffusion MR imaging and proton MR spectroscopy. AJNR Am J Neuroradiol. 2007;28:1332–8.

    Article  CAS  PubMed  Google Scholar 

  91. Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology. 2014;82:806–13.

    Article  PubMed  Google Scholar 

  92. Jevtic V. Vertebral infection. Eur Radiol. 2004;14(Suppl):43–52.

    Google Scholar 

  93. Ansari S, Amanullah M, Ahmad K, Rauniyar RK. Pott’s spine: Diagnostic imaging modalities and technology advancements. N Am J Med Sci. 2013;5:404–11.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Garcia-Monco JC. Tuberculosis. Handb Clin Neurol. 2014;121:1485–99.

    Article  PubMed  Google Scholar 

  95. Jung NY, Jee WH, Ha KY, Park CK, Byun JY. Discrimination of tuberculosis spondylitis from pyogenic spondylitis on MRI. Am J Roentgenol. 2004;182:1405–10.

    Article  Google Scholar 

  96. Li T, Liu T, Jiang Z, Cui X, Sun J. Diagnosing pyogenic, brucella and tuberculous spondylitis using histopathology and MRI: a retrospective study. Exp Ther Med. 2016;12:2069–77.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Garg RK, Malhotra HS, Gupta R. Spinal cord involvement in tuberculous meningitis. Spinal Cord. 2015;53:649–57.

    Article  CAS  PubMed  Google Scholar 

  98. Tali ET, Gultekin S. Spinal infections. Eur Radiol. 2005;15:599–607.

    Article  PubMed  Google Scholar 

  99. Trebst C, Raab P, Voss EV, Rommer P, Abu-Mugheisib M, Zettl UK, Stangel M. Longitudinal extensive transverse myelitis—it’s not all neuromyelitis optica. Nat Rev Neurol. 2011;7:688–98.

    Article  CAS  PubMed  Google Scholar 

  100. Weidauer S, Wagner M, Nichtweiß M. Magnetic resonance imaging and clinical features in acute and subacute myelopathies. Clin Neuroradiol. 2017;27:417–33.

    Article  PubMed  Google Scholar 

  101. Baldwin KJ, Zunt JR. Evaluation and treatment of chronic meningitis. Neurohospitalist. 2014;4:185–95.

    Article  PubMed  PubMed Central  Google Scholar 

  102. Chamie G, Marquez C, Luetkemeyer A. HIV-associated central nervous system tuberculosis. Semin Neurol. 2014;34:103–15.

    Article  PubMed  Google Scholar 

  103. Hughes DC, Raghavan A, Mordekar SR, Griffiths PD, Connolly DJA. Role of imaging in the diagnosis of acute bacterial meningitis and its complications. Postgrad Med J. 2010;86:478–85.

    Article  CAS  PubMed  Google Scholar 

  104. McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T. Acute bacterial meningitis in adults. Lancet. 2016;388:3036–47.

    Article  PubMed  Google Scholar 

  105. Cegielski JP, Wallace RJ. Central nervous system infections with nontuberculous mycobacteria. Clin Infect Dis. 1997;25:1496–7.

    Article  CAS  PubMed  Google Scholar 

  106. Cai R, Qi T, Lu H. Central nervous system infection with non-tuberculous mycobacteria: a report of that infection in two patients with AIDS. Drug Discov Ther. 2014;8:276–9.

    Article  PubMed  Google Scholar 

  107. Flor A, Capdevila JA, Martin N, Gavaldà J, Pahissa A. Nontuberculous mycobacterial meningitis: report of two cases and review. Clin Infect Dis. 1996;23:1266–73.

    Article  CAS  PubMed  Google Scholar 

  108. Guven T, Ugurlu K, Ergonul O, Celikbas AK, Gok SE, Comoglu S, Baykam N, Dokuzoguz B. Neurobrucellosis: clinical and diagnostic features. Clin Infect Dis. 2013;56:1407–12.

    Article  CAS  PubMed  Google Scholar 

  109. Kesav P, Vishnu VY, Khurana D. Is neurobrucellosis the Pandora’s Box of modern medicine? Clin Infect Dis. 2013;57:1056–7.

    Article  PubMed  Google Scholar 

  110. Al-Sous MW, Bohlega S, Al-Kawi MZ, Alwatban J, McLean DR. Neurobrucellosis: clinical and neuroimaging correlation. AJNR Am J Neuroradiol. 2004;25:395–401.

    PubMed  Google Scholar 

  111. Kastrup O, Wanke I, Maschke M. Neuroimaging of infections of the central nervous system. Semin Neurol. 2008;28:511–22.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Michael Nichtweiß for generously offering advice and expertise within the process of this review. Furthermore, we would like to thank Marlies Wagner and Patrick Harter for the kind contribution of histopathological and radiological images.

Author information

Authors and Affiliations

  1. Department of Neurology, Goethe University, Schleusenweg 2–16, 60528, Frankfurt/Main, Germany

    Martin Alexander Schaller & Christian Foerch

  2. Institute of General Practice, Goethe University, Frankfurt, Germany

    Felix Wicke

  3. Department of Neurology, Sankt Katharinen Hospital, Teaching Hospital, Goethe University, Frankfurt, Germany

    Stefan Weidauer

Authors
  1. Martin Alexander Schaller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Felix Wicke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christian Foerch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Weidauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Alexander Schaller.

Ethics declarations

Conflict of interest

M.A. Schaller, F. Wicke, C. Foerch and S. Weidauer declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schaller, M.A., Wicke, F., Foerch, C. et al. Central Nervous System Tuberculosis. Clin Neuroradiol 29, 3–18 (2019). https://doi.org/10.1007/s00062-018-0726-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00062-018-0726-9

Keywords

Search

Navigation