The Diagnostic Parameters in Brain Tuberculosis Meningeal and Parenchymal

The aim of this study was to study the diagnostic parameters in brain tuberculosis (meningeal and parenchymal) Material and Methods: This study was conducted in the department of Neurosurgery and Neurology SKIMS for a period of two years. A total of 61 patients presenting with brain tuberculosis admitted at skims during these two years were included in the study. Results: The most presenting symptom in our study was headache found in 95.10% followed by vomiting found in 86.90% of subjects, fever in 78.70%, altered sensorium in 49.20%, seizures in 19.70% and diplopia in18%. Out of 61 patients cranial nerve involment was found in 34(55.73%) with 11 having more than two cranial nerves involved. The most common cranial nerve involved were 3rd and 6th. ADA was positive in 36 of 53 patients of TBM with a sensitivity of 67.9% and a specificity of 75%. PCR proved to be highly specific CT scan of head was abnormal in 56 out of 61 patients (91.8%). 12 (19.70%) were in stage I (meningeal involvement only), 29 (47.50%) were in stage II (parenchymal involvement only) and 15 (24.60%) were in stage III (both parenchymal and meningeal invlolvement). The most common finding in CT head was meningeal enhancement in 43 patients, hydrocephalus in 37 patients and tuberculomas in 14 patients. The most common sites of tuberculomas were frontal lobe (n=6; 42.8%), parietal lobe (n=4; 28.5%), followed by cerebellum in 2 patients and occipital in two. Nine patients had single and five multiple tuberculomas. Of the 14 patients with tuberculomas, hydrocephalus on CT was seen in 6 patients. Conclusion: CT scan is a useful diagnostic tool even in very early stages of TBM. Abnormalities reported on CT scan done are hydrocephalus, infarcts, basal enhancement, and tuberculomas. Normal study is reported in up to 20% of the cases.

Author(s): Farooq Ahmad Ganie, Manzoor Ahmad Lone, Altaf Umar Ramzan, Mohd Arif Kelam and Masaratul- Gani

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