Tuberculosis of the central nervous system

Central nervous system (CNS) tuberculosis represents around 1% of all cases of tuberculosis. Yet, despite its relative rarity, it is an important clinical problem because it kills or maims a higher proportion of patients than any other form of tuberculosis. CNS tuberculosis takes two major forms: tuberculous meningitis (TBM) and cerebral tuberculoma. TBM causes death or severe neurological sequelae in 50% of sufferers and is the most dangerous form of tuberculosis. TBM causes progressive confusion and coma and is almost always fatal if left untreated. It should be considered a medical emergency, mandating rapid diagnosis and treatment. Cerebral tuberculomas, in contrast, are not immediately life-threatening. They are well-defined, granulomatous, space-occupying lesions, which can occur anywhere in the CNS, including the spinal cord. Their clinical manifestations depend upon their anatomical location, but an isolated seizure is the most common presentation. Tuberculomas are not immediately life-threatening unless they rupture and release bacteria into the subarachnoid space to cause TBM.