title: Neurological complications of miliary tuberculosis.
abstract: BACKGROUND
  The symptomatic central nervous system involvement is often seen in patients with miliary tuberculosis.
  
  
  METHODS
  In this study, we evaluated 60 consecutive miliary tuberculosis patients, who presented with some neurological manifestations. Evaluation included neurological examination, a battery of blood tests, HIV serology, sputum examination, cerebrospinal fluid (CSF) examination along with imaging of the brain and spinal cord. The patients were followed up after completion of 6 months of antituberculous treatment.
  
  
  RESULTS
  Patients ranged between 14 and 53 years in age. Three patients tested HIV positive. Forty-eight (80%) patients had tuberculous meningitis. In 12 (20%) patients, the CSF examination was normal. In 27 patients with tuberculous meningitis, neuroimaging revealed intracerebral tuberculoma. Fourteen patients showed multiple tuberculomas, while 7 had a solitary tuberculoma. In six patients, the tuberculomas were small and numerous. In two patients, neuroimaging revealed a spinal tuberculoma. For three patients with tuberculous brain masses, the CSF was normal. Nine (15%) patients presented with myelopathy. Three patients exhibited Pott's paraplegia. Three patients had transverse myelitis (with normal neuroimaging). In three patients, the spinal MRI revealed an intramedullary tuberculoma. On follow-up, 15 (25%) patients expired. Thirty-one (52%) patients showed significant improvement. Eight patients (13%) showed nil or partial recovery. Six of the patients with no improvement developed vision loss. Six (10%) patients were lost to follow up.
  
  
  CONCLUSIONS
  A variety of neurological complications were noted in military tuberculosis patients, tuberculous meningitis and cerebral tuberculomas being the most frequent complications. However, a majority of patients improved following antituberculous treatment.
authors.affiliation: Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow 226003, Uttar Pradesh, India. garg50@yahoo.com <garg50@yahoo.com>
authors.forename: Ravindra Kumar
authors.initials: RK
authors.lastname: Garg
authors.forename: Rohitash
authors.initials: R
authors.lastname: Sharma
authors.forename: Alok Mohan
authors.initials: AM
authors.lastname: Kar
authors.forename: Ram Avadh Singh
authors.initials: RA
authors.lastname: Kushwaha
authors.forename: Maneesh Kumar
authors.initials: MK
authors.lastname: Singh
authors.forename: Rakesh
authors.initials: R
authors.lastname: Shukla
authors.forename: Atul
authors.initials: A
authors.lastname: Agarwal
authors.forename: Rajesh
authors.initials: R
authors.lastname: Verma
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001921:Brain / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006678:HIV; D006679:HIV Seropositivity / Q000097:blood; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D013116:Spinal Cord / Q000473:pathology*; D016896:Treatment Outcome; D014375:Tuberculoma / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D014390:Tuberculosis, Meningeal / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000209:etiology; D014391:Tuberculosis, Miliary / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents