Neuro-radiology: a new gold standard investigation for management of central nervous system tuberculosis

  • Authors

    • Vinod Gautam IHBAS, Delhi, India
    2016-02-20
    https://doi.org/10.14419/ijm.v4i1.5758
  • CNS Tuberculosis, Neuro-radiology

  • Treatment of CNS TB is challenging due to lack of specific biochemical tests and inability to get the pathological sample from deeply located eloquent areas of CNS without causing any neurological deficit. Moreover, it is unnecessary to operate for biopsy in a patient who has presented with a very small granulomatious lesion in brain or spinal cord. In such as situations neuro-radiology helps in managing CNS TB and it may be the only source of establishing diagnosis and evaluating treatment response.

    Role of radiological investigation has expanded from the initial diagnosis to the therapeutic interventions. In some Muli-drug- resistant (MDR) CNS TB cases, Stereotaxy or USG or CT guided biopsy helps in obtaining pathological sample and drug sensitivity testing. A regular clinical and neuro-radiological follow-up is mandatory during the entire course of anti tuberculous therapy to take prompt decisions to change ATT and to reduce morbidity and mortality associated with CNS TB.

    Author Biography

    • Vinod Gautam, IHBAS, Delhi, India
      Assistant Professor Neurosurgery

  • References

    1. [1] Gautam VKS, Khurana S & Singh R (2013) Diagnostic and therapeutic challenges in the surgical management of CNS tuberculosis. International Journal of Medicine and Health Sciences, Vol-2;Issue-2, 161-169.

      [2] Girgis NI, Sultan Y, Farid Z, Mansour MM, Erian MW & Hanna LS (1998) Tuberculosis meningitis, Abbassia Fever Hospital-Naval Medical Research Unit No. 3.Cairo, Egypt, from 1976 to 1996. American Journal of Tropical Medicine and Hygiene. 58(1), 28-34.

      [3] Malik ZI, Ishtiaq O, Shah NH, Anwer F & Baqai HZ (2002) Analysis and outcome of 30 patients with Tuberculous Meningitis. Pakistan Journal of Medical Research, Vol.41 No.4, 137-141.

      [4] Davis LE, Rastogi KR, Lambert LC & Skipper BJ (1993) tuberculous meningitis in the Southwest United States: a community based study. Neurology; 43(9):1775-8. http://dx.doi.org/10.1212/WNL.43.9.1775.

      [5] Tariq M & Sheikh M (1994) Factors affecting the outcome in tuberculous meningitis. J Surg; 8-9:16-8.

      [6] Alsoub H (1998) Tuberculous meningitis:a clinical and laboratory study of 20 patients in Qatar. International Journal of Clinical Practice. 52(5):3004.

      [7] Venugopal K, Sreelatha PR, Philip S & Kumar V (2008) Treatment outcome of neurotuberculosis patients put on DOTS--an observation study from the field. Indian Journal of Tuberculosis. 55, 199-202

      [8] Gautam VKS, Khurana S & Singh R (2013) Primary Calvarial Tuberculosis (PCT) presenting as cold abscess of the scalp: A report of two cases. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), Volume 4, Issue 4, 14-17. http://dx.doi.org/10.9790/0853-0441417.

      [9] Gautam VKS & Singh R (2013) surgical management of Neurotuberculosis- Review of radiological spectrum. International Journal of Health.1 (1), 1-7. http://dx.doi.org/10.14419/ijh.v1i1.941.

      [10] De Backer AI, Mortelé KJ, Vanschoubroeck IJ, Deeren D, Vanhoenacker FM, De Keulenaer BL, Bomans P & Kockx MM (2005) Tuberculosis of the spine: CT and MR imaging features. JBR–BTR, 88 (2) 92-97

      [11] Moore SL & Rafii M (2001) Imaging of musculoskeletal and spinal tuberculosis. Radiol Clin North America, 39, 329-342. http://dx.doi.org/10.1016/S0033-8389(05)70280-3.

      [12] Gautam VKS, Srivastava A, Khare A, Singh R (2014) CNS Tuberculoma mimicking brain metastasis. International journal of medicine, 2 (2), 68-70. http://dx.doi.org/10.14419/ijm.v2i2.3452.

      [13] Trivedi R, Saksena S, Gupta RK (2009) Magnetic resonance imaging in central nervous system tuberculosis. The Indian Journal of Radiology & Imaging.19 (4), 256-265. http://dx.doi.org/10.4103/0971-3026.57205.

      [14] Gupta RK, Gupta S, Singh D, Sharma B, Kohli A & Gujral RB (1994) MR imaging and angiography in tuberculous meningitis. Neuroradiology. 36:87-92. http://dx.doi.org/10.1007/BF00588066.

      [15] Gupta RK, Kathuria MK & Pradhan S (1999) Magnetization transfer MR imaging in CNS tuberculosis. AJNR Am J Neuroradiol.20867–75.

      [16] Gupta R (2002) Magnetization transfer MR imaging in central nervous system infections. Indian Journal Radiological Imaging. 1251–58.

      [17] Bernaerts A, Vanhoenacker FM, Parizel PM, Van Goethem JW, Van Altena R, Laridon A, De Roeck J, Coeman V & De Schepper AM (2003) Tuberculosis of the central nervous system: overview of neuroradiological findings. Eur. Radiol. 13:1876–1890. http://dx.doi.org/10.1007/s00330-002-1608-7.

      [18] Jinkins JR, Gupta R,. Chang KH & Rodriguez-Carbajal J (1995) MR imaging of central nervous system tuberculosis. Radiol. Clin. N. Am. 33:771–786.

      [19] Kioumehr F, Dadsetan MR, Rooholamini SA &. Au A (1994) Central nervous system tuberculosis: MRI. Neuroradiology 36:93–96. http://dx.doi.org/10.1007/BF00588067.

      [20] Offenbacher H, Fazekas F, Schmidt R, Kleinert R, Payer F, Kleinert G & Lechner H (1991) MRI in tuberculous meningoencephalitis: report of four cases and review of the neuroimaging literature. J. Neurol. 238:340– 344. http://dx.doi.org/10.1007/BF00315335.

      [21] Kumar R, Kohli N, Thavnani H, Kumar A & Sharma B (1996) Value of CT scan in the diagnosis of meningitis. Indian Pediatr. 33:465–468.

      [22] Greenberg Mark S (2010) Handbook of Neurosurgery, 7th Edition, Thieme

      [23] Andronikou S & Wieselthaler N (2004) Modern imaging of tuberculosis in children: thoracic, central nervous system and abdominal tuberculosis. Pediatr. Radiol. 34:861–875. http://dx.doi.org/10.1007/s00247-004-1236-2.

      [24] Przybojewski S, Andronikou S & Wilmshurst J (2006) Objective CT criteria to determine the presence of abnormal basal enhancement in children with suspected tuberculous meningitis. Pediatr. Radiol. 36:687–696. http://dx.doi.org/10.1007/s00247-006-0160-z.

      [25] Kamra P, Azad R, Prasad KN, Jha S, Pradhan S & Gupta RK (2004) Infectious meningitis: prospective evaluation with magnetization transfer MRI. British Journal of Radiology, 77, 387–94. http://dx.doi.org/10.1259/bjr/23641059.

      [26] Tandon PN, Bhatia R & Bhargava S (1988) “Tuberculous meningitis†In: Vinken PJ, Bruyn GW, Klawans HZ, editors. Handbook of Clinical Neurology. Vol 8. Amsterdam: Elsevier; 196–226.

      [27] Singh I, Haris M, Husain M, Husain N, Rastogi M & Gupta RK ( 2008) Role of endoscopic third ventriculostomy in patients with communicating hydrocephalus: an evaluation by MR ventriculography. Neurosurgery Review, 31,319–325. http://dx.doi.org/10.1007/s10143-008-0137-5.

      [28] Dastur DK, Lalitha VS, Udani PM & Parekh U (1970) The brain and meninges in tuberculous meningitis-gross pathology in 100 cases and pathogenesis. Neurology India.18, 86–100.

      [29] Shukla R, Abbas A, Kumar P, Gupta RK, Jha S & Prasad KN (2008) Evaluation of cerebral infarction in tuberculous meningitis by diffusion weighted imaging. J Infect. 57, 298–306. http://dx.doi.org/10.1016/j.jinf.2008.07.012.

      [30] Brismar J, Hugosson C, Larsson SG, Lundstedt C & Nyman R (1996) Tuberculosis as a mimicker of brain tumor. Acta Radiol; 37:496–505. [PubMed: 8688230]

      [31] Goyal M, Sharma A, Mishra NK, Gaikwad SB & Sharma MC (1997). Imaging appearance of pachymeningeal tuberculosis. AJR Am J Roentgenol, 169:1421–4. [PubMed: 9353472] http://dx.doi.org/10.2214/ajr.169.5.9353472.

      [32] Tandon PN & Pathak SN (1973) Tuberculosis of the central nervous system. In: Spillane JD, editor. In Tropical Neurology. New York: Oxford University Press; 37–62.

      [33] Gupta RK & Lufkin RB (2001) MR imaging and spectroscopy of central nervous system infection; in Tuberculosis and other non-tuberculous bacterial granulomatous infection. New York: Kluwer Academic, Plenum Publishers, 95–145 http://dx.doi.org/10.1007/b111688.

      [34] Khoo JLS, Lau KY, Cheung CM & Tsoi TH (2003) Central Nervous System Tuberculosis. J HK Coll Radiol, 6, 217-228

      [35] Bargallo J, Berenguer J, Garcia-Barrionuevo J, Ubeda B, Bargallo N, Cardenal C & Mercader JM (1996) The “target signâ€: is it a specific sign of CNS tuberculoma? Neuroradiology 38:547–550. http://dx.doi.org/10.1007/BF00626095.

      [36] Poptani H, Gupta RK, Roy R, Pandey R, Jain VK & Chhabra DK (1995) Characterization of intracranial mass lesions with in vivo proton MR spectroscopy. AJNR Am J Neuroradiol; 16:1593–603.

      [37] Gupta RK, Jena A, Singh AK, Sharma A, Puri V & Gupta M (1990) Role of magnetic resonance (MR) in the diagnosis and management of intracranial tuberculomas. Clin Radiol; 41:120–7. http://dx.doi.org/10.1016/S0009-9260(05)80143-6.

      [38] Gupta RK, Pandey R, Khan EM, Mittal P, Gujral RB & Chhabra DK (1993) intracranial tuberculomas: MRI signal intensity correlation with histopathology and localized proton spectroscopy. Magn Reson Imaging.; 11:443–9. http://dx.doi.org/10.1016/0730-725X(93)90079-S.

      [39] Gupta RK, Poptani H, Kohli A, Chhabra DK, Sharma B & Gujral RB (1995) In vivo localized proton magnetic resonance spectroscopy of intracranial tuberculomas. Indian J Med Res; 101:19–24.

      [40] Gupta RK, Roy R, Dev R, Husain M, Poptani H, Pandey R, Kishore J & Bhaduri AP (1996) Finger printing of Mycobacterium tuberculosis in patients with intracranial tuberculomas by using in vivo, ex vivo, and in vitro magnetic resonance spectroscopy. Magn Reson Med; 36:829–33. http://dx.doi.org/10.1002/mrm.1910360605.

      [41] Gupta RK & Roy R (1999) MR imaging and spectroscopy of intracranial tuberculoma. Current Sci; 76:783–8.

      [42] Whitener DR (1978) tuberculous brain abscess. Report of a case and review of the literature. Arch Neurol; 35, 148–85 http://dx.doi.org/10.1001/archneur.1978.00500270030007.

      [43] Farrar DJ, Flanigan TP, Gordon NM, Gold RL, Rich JD (1997) Tuberculous brain abscess in a patient with HIV infection: case report and review. Am J Med; 102:297–301? [PubMed: 9217600] http://dx.doi.org/10.1016/S0002-9343(97)00386-0.

      [44] Gupta RK, Vatsal DK, Husain N, Chawla S, Prasad KN, Roy R, Jha D & Husain M (2001) Differentiation of tuberculous from pyogenic brain abscesses with in vivo proton MR spectroscopy and magnetization transfer MR imaging. AJNR Am J Neuroradiol.; 22:1503–9.

      [45] Gautam VKS, Singh R & Khurana S (2013) Brainstem Tuberculoma Presenting As Stroke. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). Volume 4, Issue 6, 18-19.

      [46] Gautam VKS, Singh R & Khurana S (2013) Transient Behavior Abnormality following injury to Splenium of corpus callosum during ventriculoperitoneal shunt Surgery. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS).Volume 5, Issue 1, 26-29.

      [47] VKS Gautam, Singh R & Khurana S (2014) Hydrocephalus treated with VP shunt surgery: a clinical audit. International Journal of Health.2 (2), 26-29. http://dx.doi.org/10.14419/ijh.v2i2.2849.

      [48] VKS Gautam, Singh R & Khurana S (2014) Reviewing hydrocephalus: Personal experience of a Neurosurgeon with ventriculoperitoneal shunts treatment. International Journal of Health.2 ( 2) 2014, 56-59.

      [49] Ersahin M, Hakan T, Ayan E, Berkman Z, Ekinci O, Ceran N & Vardar Aker F (2010) Diagnostic and therapeutic role of CT- guided stereotactic surgery in the managemnt of intracranial tuberculomas. Turkish neurosurgery, Vol: 20, No:3,295-302

      [50] Report from the Meiacal Research Council Tuberculosis and Chest disease Unit (1980) National Suvey of tuberculosis notifications in Englnd and Wales 1978-79, Br. Med J; 281: 895-898.

      [51] Gupta KB, Kumar A, Sen R, Sen J &Verma M (2007) Role of ltrasonography and computed tomography in complicated cases of tuberculous cervical lymphadenitis. Indian Journal of Tuberculosis, 54;71-78.

      [52] Gulati Y & Gupta R (2005) Operative treatment of tuberculosis of dorsal and lumbar spine Apollo Medicine, June, Vol. 2, No. 2, 96-100.

      [53] Kumar R (2005), Spinal tuberculosis: with reference to the children of northern India. Childs Nervous System. Jan, 21(1), 19-26. http://dx.doi.org/10.1007/s00381-004-1029-9.

      [54] Murphy KJ, Brunberg JA, Quint DJ & Kazanjian PH (1998) Spinal cord infection: myelitis and abscess formation. AJNR Am J Neuroradiol; 19:341–8. [PubMed: 9504492]

      [55] Sharif HS, Aabed MY, Haddad MC (1992) “Magnetic resonance imaging and computed tomography of infectious spondylitis†In: Bloem JL, Satoris DJ, editors. MRI and CT of the musculoskeletal system: a text atlas. Baltimore: Williams and Wilkins; 1992. pp. 580–602.

      [56] Brooks WD, Fletcher AP & Wilson RR (1954) Spinal cord complications of tuberculous meningitis; a clinical and pathological study. Q J Med; 23:275–90. [PubMed: 13194846]

      [57] Aiimsnets.org/ Spinalsurgery

      [58] Jaiswal AK, Jaiswal S, Gupta SK, Singh Gautam VK & Kumar S (2006) Intramedullary tuberculoma of the conus. J Clin Neurosci., Oct; 13(8):870-2. http://dx.doi.org/10.1016/j.jocn.2005.11.032.

  • Downloads

  • How to Cite

    Gautam, V. (2016). Neuro-radiology: a new gold standard investigation for management of central nervous system tuberculosis. International Journal of Medicine, 4(1), 14-22. https://doi.org/10.14419/ijm.v4i1.5758