Tuberculosis of the central nervous system

Tuberculous involvement of the brain and spinal cord are common neurologica l disorders in developing countries and have recently shown a resurgence in developed ones. Tuberculous meningitis is an important manifestation and i s associated with high morbidity and mortality. Diagnosis is based on clini cal features, cerebrospinal fluid changes, and imaging characteristics. Bac teriological confirmation is not possible in all cases as serological tests do not have sufficient sensitivity and specificity. The polymerase chain r eaction shows promise for the future. Appropriate chemotherapeutic agents s hould be administered as early as possible, although there is no unanimity concerning chemotherapeutic regimens or optimal duration of treatment. The patient's clinical stage at presentation is the most important prognostic f actor. The role of corticosteroids is controversial but they should be admi nistered to all patients presenting in stage III. Surgical procedures are d irected at management of the hydrocephalus. Focal lesions, intracranial tub erculomas, and tuberculous abscesses, are usually located in cerebral or ce rebellar hemispheres, uncommonly in brainstem and very rarely in spinal cor d. They do not usually require surgical intervention and respond well to an tituberculous treatment, along with corticosteroids.