Neurological complications of miliary tuberculosis.
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.
Garg
Ravindra Kumar
RK
Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow 226003, Uttar Pradesh, India. garg50@yahoo.com <garg50@yahoo.com>
Sharma
Rohitash
R
Kar
Alok Mohan
AM
Kushwaha
Ram Avadh Singh
RA
Singh
Maneesh Kumar
MK
Shukla
Rakesh
R
Agarwal
Atul
A
Verma
Rajesh
R
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
D000995:Antitubercular Agents