[Involvement of the central nervous system in disseminated tuberculosis].
Four weeks after starting tuberculostatic treatment (with isoniazid, rifampicin, streptomycin and pyrazinamide) a 21-year-old man with pulmonary tuberculosis developed symptoms of a radiculomyelopathy as well as mild renal failure. After isoniazid and streptomycin had been discontinued and ethambutol and high doses of vitamin B6 had been added all signs and symptoms improved. However, 4 weeks later tuberculous meningitis occurred which at first seemed to respond to administration of 5 antituberculosis drugs and dexamethasone. But 3 weeks later the patient sustained a partial hemiparesis. Its cause was proven to be a tuberculoma in the region of the brainstem. During further administration of tuberculostatic drugs and glucocorticoids the symptoms gradually receded over 8 months. A 54-year-old man with pulmonary tuberculosis developed cranial nerve pareses and symptoms of cerebellar involvement (trunk ataxia, intention tremor, dysdiadochokinesia) 3 weeks after starting tuberculostatic treatment. Computed tomography revealed multiple intracerebral tuberculomas which gradually shrank with continuation of the tuberculostatic treatment plus glucocorticoids. These two case reports illustrate that in tuberculosis involvement of the CNS can express itself clinically through complex symptoms, sometimes even after the start of tuberculostatic treatment.
Hoheisel
G
G
Medical Department, Haven of Hope Hospital, Hong Kong.
Chan
K M
KM
Dai
L K
LK
Chan
K S
KS
Sun
A J
AJ
Luk
W K
WK
Chan
C H
CH
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D001933:Brain Stem; D002493:Central Nervous System Diseases / Q000188:drug therapy / Q000209:etiology*; D002526:Cerebellar Diseases / Q000209:etiology; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014375:Tuberculoma / Q000000981:diagnostic imaging / Q000209:etiology; D014376:Tuberculosis / Q000000981:diagnostic imaging / Q000188:drug therapy; D014390:Tuberculosis, Meningeal / Q000209:etiology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy
D000305:Adrenal Cortex Hormones; D000995:Antitubercular Agents
Beteiligung des Zentralnervensystems bei disseminierter Tuberkulose.