title: Tuberculous brain abscesses in immunocompetent patients: A decade long experience with nine patients.
abstract: OBJECTIVE
  To describe the clinical presentation, radiological findings, management details, and outcome in nine cases of tuberculous brain abscess (TBA).
  
  
  METHODS
  Nine patients (5 females, 4 males) harboring a TBA, as defined by the Whitener's criteria, were managed over a span of one and a half decade by the authors. All, except one patient, underwent contrast-enhanced magnetic resonance imaging scans, followed by surgical excision of the abscesses due to the failure of complete resolution of the lesion after its drainage using a burr-hole.
  
  
  RESULTS
  The infra-tentorial location (n = 4) in TBAs was as common as the supra-tentorial location (n = 4). All large TBAs (more than 3 cm in diameter) failed to resolve after tapping of the purulent material and required surgical excision for a favorable long-term outcome. Two patients expired, while seven patients survived with Karnofsky Performance scale of 90 for 3, 80 for 3, and 70 for 1 patient. The follow-up ranged from 2 to 12 years (mean = 5.7 years).
  
  
  CONCLUSIONS
  TBAs should be considered in the list of differential diagnoses for pyogenic abscesses, especially in developing countries, as it is difficult to differentiate between them on the basis of clinical or radiological findings. Hence, all pus samples should be sent for Ziehl-Neelsen staining and culture for Mycobacterium tuberculosis. Surgically excised and pathologically evaluated specimens remain the gold-standard for diagnosing TBAs. Larger abscesses warrant surgical excision, while concomitantly associated smaller lesions tend to resolve with prolonged antituberculous therapy.
authors.affiliation: Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Mohindra
authors.forename: Amey
authors.initials: A
authors.lastname: Savardekar
authors.forename: Rahul
authors.initials: R
authors.lastname: Gupta
authors.forename: Manjul
authors.initials: M
authors.lastname: Tripathi
authors.forename: Swapnil
authors.initials: S
authors.lastname: Rane
mesh_terms: D001922:Brain Abscess / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D014057:Tomography, X-Ray Computed; D020306:Tuberculosis, Central Nervous System / Q000000981:diagnostic imaging*