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Tuberculosis

Brain Tuberculosis

03/25/2010

Question:

8 months ago my mother fainted as she has high sugars. We thought because of sugar she was unconcious, but her condition was going worse. So after 2-3 MRIs she was diagnosed with Brain TB. Treatment is going on, but after this much time her condition is still the same. She talks irrationally, can`t stand without assistance, and is completly senseless. Can you please tell me will she be fine?? How much time she will take to get well? We are worrying about her. Thanks.

Answer:

Without knowing the type of tuberculosis (TB) of the brain your mother has or how the diagnosis was made, it is very difficult for us to comment about her condition or how soon she will recover from her illness. You stated she had 2 - 3 MRIs but was there a spinal fluid evaluation? Were there any culture or drug susceptibilities performed? You should discuss your specific concerns with her doctor.

We will try to provide you with general comments regarding TB of the brain or Central Nervous System (CNS). TB meningitis (or inflammation of the brain) is the most common form of CNS TB. Before medication for treatment of TB was available, most people with TB meningitis died. Patients with TB meningitis may present with symptoms that are confused with other medical problems, as in your mother's case. The onset of symptoms may be slow, taking weeks to months. Usually, patients present with fever, not feeling well, decreased appetite, headache, irritability, backache, and occasional vomiting. If patients do not receive medical treatment, then the symptoms gets worse, with increasing headaches, inability to stay awake, personality changes, memory problems, and confusion. They may also experience seizures. The last stage is coma, where they cannot be aroused.

The next type of TB is a TB lesion (tuberculoma) in the brain. In areas of the world where there is a lot of TB, tuberculomas are the most common cause of brain lesions. It is rare in developing countries. Depending on where in the brain the tuberculoma is, it can cause symptoms of unsteadiness (ataxia) and headache. An MRI may be suggestive of TB but cannot differentiate it from other tumors without a biopsy.

TB of the brain is a very serious medical condition and it can be very difficult to diagnose. Often times, it may not be possible for the doctors to perform spinal fluid analysis or biopsy. Patients are usually started on treatment for TB disease because there is a risk for TB exposure if the disease is also present in the lungs. Most patients recover but sometimes patients may not recover fully. Close follow-up with a TB specialist and neurologist is recommended.

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Response by:

Shu-Hua   Wang, MD, MPH&TM Shu-Hua Wang, MD, MPH&TM
Clinical Assistant Professor of Infectious Diseases
Clinical Assistant Professor of The Division of Epidemiology
College of Medicine
The Ohio State University

Larry S Schlesinger, MD Larry S Schlesinger, MD
Professor:
Molecular Virology, Immunology and Medical Genetics
Microbiology Administration
Environmental Health Sciences
College of Medicine
The Ohio State University