Der Nervenarzt

, Volume 79, Issue 2, pp 153–166 | Cite as

Neurotuberkulose

Eine anhaltende klinische Herausforderung
  • B.-M. Mackert
  • J. Conradi
  • C. Loddenkemper
  • F.K.H. van Landeghem
  • R. Loddenkemper
  • R. Ignatius
  • T. Schneider
Übersichten

Zusammenfassung

Die Neurotuberkulose ist in Deutschland eine eher seltene Erkrankung. Wegen der therapeutischen Konsequenzen und einer Vielzahl von Differenzialdiagnosen ist die Kenntnis dieser Erkrankung trotzdem sehr wichtig. Die Diagnose der Neurotuberkulose wird in der Zusammenschau des klinischen Erscheinungsbildes, der Liquordiagnostik sowie der zerebralen Bildgebung gestellt. Eine frühzeitige Diagnosestellung, der unverzügliche Beginn einer adäquaten antituberkulotischen Therapie und das klinische Stadium sind die prognostisch wichtigen Faktoren für den langfristigen Heilungserfolg. Trotz der Verfügbarkeit von effektiven Chemotherapeutika lässt sich die Neurotuberkulose häufig nicht zufriedenstellend therapieren. In weniger als der Hälfte der Fälle kann eine bleibende Beeinträchtigung oder der Tod verhindert werden. Neuere Arbeiten belegen, dass eine rechtzeitige und adäquate adjuvante Kortikoidtherapie die Prognose hinsichtlich der Letalität und Morbidität verbessert. Resistenzentwicklungen des wichtigsten Erregers, Mycobacterium tuberculosis, erschweren die Therapie.

Die neueren Erkenntnisse vor allem zur Diagnostik und Therapie werden zusammengefasst und anhand von Fallbeispielen dargestellt.

Schlüsselwörter

Neurotuberkulose Differenzialdiagnostik Chemotherapeutika Kortikoide Resistenzentwicklung Mycobacterium tuberculosis 

Neurotuberculosis

A continuing clinical challenge

Summary

In Germany neurotuberculosis is quite rare. Familiarity with the disease is nonetheless important because of many differential diagnoses and therapeutic implications. The diagnosis of neurotuberculosis is made by considering of clinical presentation, CSF, and cerebral imaging. Early diagnosis, prompt initiation of effective antitubercular therapy, and clinical staging are necessary for establishing a long-term treatment prognosis. The results of neurotuberculosis therapy are often unsatisfactory despite the availability of effective drugs. Lasting damage or death can be averted in fewer than half of the patients. Studies now confirm that early adjuvant corticoid therapy reduces lethality and morbidity. Resistant new strains of the pathogen, Mycobacterium tuberculosis, complicate therapy. Recent discoveries especially in diagnosis and therapy are explained using case evidence.

Keywords

Chemotherapeutic substances Corticoids Development of resistance Differential diagnosis Mycobacterium tuberculosis Neurotuberculosis 

Notes

Danksagung

Thomas Schneider wird zurzeit als Leiter der Klinischen Forschergruppe 104 „Immunpathogenese und Interventionsstrategien bei mukosalen Infektionen“ zur Hälfte von der Deutschen Forschungsgemeinschaft und zur anderen Hälfte von der Freien Universität Berlin finanziert.

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  • B.-M. Mackert
    • 1
  • J. Conradi
    • 1
  • C. Loddenkemper
    • 3
  • F.K.H. van Landeghem
    • 4
  • R. Loddenkemper
    • 6
  • R. Ignatius
    • 5
  • T. Schneider
    • 2
  1. 1.Klinik für NeurologieCharité – Universitätsmedizin Berlin, Campus Benjamin Franklin BerlinDeutschland
  2. 2.Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie und RheumatologieCharité – Universitätsmedizin Berlin, Campus Benjamin Franklin BerlinDeutschland
  3. 3.Institut für PathologieCharité – Universitätsmedizin Berlin, Campus Benjamin Franklin BerlinDeutschland
  4. 4.Institut für NeuropathologieCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinDeutschland
  5. 5.Institut für Mikrobiologie und HygieneCharité – Universitätsmedizin Berlin, Campus Benjamin Franklin BerlinDeutschland
  6. 6.Deutsches Zentralkomitee zur Bekämpfung der TuberkuloseBerlinDeutschland

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