The Italian Journal of Neurological Sciences

, Volume 10, Issue 2, pp 163–170 | Cite as

Reversible multifocal encephalopathy following tuberculous infection

  • Provinciali L. 
  • Pesce M. Del 
  • Censori B. 
  • Pasquini U. 
Original Articles

Abstract

Tuberculous encephalic infection is commonly reported as confined to Asians or Africans or people living in poor hygienic conditions; very often it follows meningitis in patients with lung TB infection. We describe three western patients coming from good social environment and suffering from multifocal tuberculous encephalopathy. Two of them showed neither meningitis or lung TB when CNS involvement appeared. Complete recovery after therapy is described, together with the evolution of brain CT and, in 1 case, MRI features. The instrumental findings accompanying the complete recovery suggest that the lesions described in these cases are a localized form of encephalitis responsive to medical treatment, unlike tuberculomas, which often need surgical treatment. The occurrence of tuberculous encephalic infection in western, middle-class patients with or without meningitis emphasizes that tuberculous encephalopathy must be considered in the differential diagnosis of multifocal brain lesions.

Key-Words

Tuberculous encephalopathy tuberculomas localized encephalitis computed tomography magnetic resonance imaging 

Sommario

L'infezione encefalica tubercolare è comunemente descritta come esclusiva di individui asiatici o africani, o di soggetti che vivono in scadenti condizioni igieniche; molto spesso essa segue la meningite nei pazienti con evidente tubercolosi polmonare. Vengono qui descritti tre casi di encefalopatia tubercolare multifocale in pazienti italiani di buona condizione socio-economica. Due di essi non mostravano né meningite né tubercolosi polmonare quando comparvero i segni di compromissione del S.N.C.

In particolare viene descritto il completo recupero dopo terapia medica e vengono riportate le caratteristiche TAC e, in un caso, di Risonanza Magnetica Nucleare. I dati strumentali suggeriscono che questi casi rappresentano una forma localizzata di encefalite, sensibile al trattamento medico, a differenza dei tubercolomi che richiedono spesso il trattamento chirurgico. Il verificarsi di infezione encefalica tubercolare in pazienti occidentali di buon livello socio-economico suggerisce che la encefalopatia tubercolare deve rientrare nella diagnosi differenziale delle lesioni cerebrali multifocali.

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References

  1. [1]
    Thrush D.C., Barwich D.D.:Three patients with intracranial tuberculomas with unusual features. J. Neurol. Neurosurg. Psychiatry, 37:566–569, 1974.PubMedGoogle Scholar
  2. [2]
    Anderson J.M., Macmillan J.J.:Intracranial tuberculoma —an increasing problem in Britain. J. Neurol. Neurosurg. Psychiatry, 38:194–201, 1975.PubMedGoogle Scholar
  3. [3]
    Trautmann M., Kluge W., Otto H.S., Loddenkemper R.:Computed tomography in CNS tuberculosis. Eur. Neurol., 25:91–97, 1986.PubMedGoogle Scholar
  4. [4]
    Sibley W.A., O'Brien J.L.:Intracranial tuberculomas: a review of clinical features and treatment. Neurology, 6:157–165, 1956.PubMedGoogle Scholar
  5. [5]
    Mayers M.M., Kaufman D.M., Miller H.H.:Recent cases of intracranial tuberculomas. Neurology, 28:256–260, 1978.PubMedGoogle Scholar
  6. [6]
    Udani P.M., Dastur D.K.:Tuberculous encephalopathy with and without meningitis. Clinical features and pathological correlations. J. Neurol., Sci., 10:541–561, 1978.Google Scholar
  7. [7]
    Dastur D.J., Desai A.D.:A comparative study of brain tuberculomas and gliomas based upon 107 case records of each. Brain, 88:375–396, 1965.PubMedGoogle Scholar
  8. [8]
    Peatfield R.C., Shawdon H.H.:Five cases of intracranial tuberculomas followed by serial computerized tomography. J. Neurol. Neurosurg. Psychiatry, 42:373–379, 1979.PubMedGoogle Scholar
  9. [9]
    Rossi L.N., Duzioni N., Terzi F.:Intracranial tuberculomas in a child: regression on the CT scan under conservative therapy. Neuropediatrics, 16.228–203, 1985.PubMedGoogle Scholar
  10. [10]
    Bachman D.:Computerized tomography in a verified case of tuberculous meningitis. Neurology, 30:347, 1980.PubMedGoogle Scholar
  11. [11]
    Daustur H.M.:Tuberculoma. In: Vinken P.J., Bruyn Q.W. (Eds.), Handbook of Clinical Neurology: Vol. 18. Amsterdam, Elsevier Science Publ., 413–425, 1975.Google Scholar
  12. [12]
    Wadia R.S., Makhale C.N., Kelkar A.V., Grant K.B.:Focal epilepsy in India, with special reference to lesions showing ring-or disc-enhancement on contrast computed tomography. J. Neurol., Neurosurg. Pshychiatry, 50:1298–1301, 1987.Google Scholar
  13. [13]
    Chari C.R., Rao N.S.:Transient neurologic deficits as a presentation of tuberculosis of the central nervous system. Neurology, 37:1884–1885, 1987.PubMedGoogle Scholar
  14. [14]
    Molavi A., Lefrock J.L.:Tuberculous meningitis. Med. Clin. North. Amer., 69:315–331, 1985.Google Scholar
  15. [15]
    Swart S., Briggs R.S., Millac P.A.:Tuberculous meningitis in Asian patients. Lancet, 2:15–16, 1981.PubMedGoogle Scholar
  16. [16]
    De Angelis L.:Intracranial tuberculoma. Case report and review of the literature. Neurology, 31:1133–1136, 1981.Google Scholar
  17. [17]
    Berthier M., Sierra J., Leiguarda R.:Intraventricular tuberculomas. Neuroradiology., 29:163–167, 1987.CrossRefPubMedGoogle Scholar
  18. [18]
    Kennedy D.A., Fallon R.J.:Tuberculous meningitis. Jama, 241–264–2013;268 1979.Google Scholar
  19. [19]
    Barret-Connor R.:Tuberculous meningitis in adults. South. Med. J., 60:1061–1067, 1967.Google Scholar
  20. [20]
    Lehrich J.R., Richardson E.P.:Case record. N. Engl. J. Med., 306:91–97, 1982.Google Scholar
  21. [21]
    Naughten E., Weindling A.M., Newton R., Bower B.D.:Tuberculous meningitis in children. Lancet, 2:973–975, 1981.PubMedGoogle Scholar
  22. [22]
    Bhargava S., Tandon P.N.:Intracranial tuberculomas: a CT study. Brit J Radiol., 53:935–945, 1980.PubMedGoogle Scholar
  23. [23]
    Donovan Post M.J., Hoffman T.A.:Mycobacterial infection. In: Rosenberg R.N. (ed.), The Clinical Neurosciences, Vol. 4. New York, Churchill Livingston, 563–565, 1984.Google Scholar
  24. [24]
    Sethi P.K., Kumar B.R., Madan V.S., Mohan V.:Appearing and disappearing CT scan abnormalities and seizures. J. Neurol. Neurosurg., Psychiatry, 48:866–869, 1985.Google Scholar
  25. [25]
    Arseni C.:Two hundred and one cases of intracranial tuberculomas treated surgically. J. Neurol. Neurosurg. Psychiatry, 21:308–311, 1958.PubMedGoogle Scholar
  26. [26]
    Asenjo A., Valladares H., Fierro J.:Tuberculomas of the brain. Report of one hundred fifty-nine cases. Arch. Neurol. Psychiat., 65:146–160, 1951.Google Scholar
  27. [27]
    Schrot G., Kretzschmar K., Gawehn J.:Advantage of magnetic resonance imaging in the diagnosis of cerebral infections. Neuroradiology, 29:120–126, 1987.Google Scholar
  28. [28]
    Vignaud J., Bocquet M., Aubin M.L., Iba Zizen M.T., Stoffels C.:IRM des tumeurs intra-axiales de la fosse postérieure. J. Neuroradiol., 11:249–261, 1984.PubMedGoogle Scholar
  29. [29]
    Venger B.H., Dion F.M., Rouah E., Handel S.F.:MR imaging of pontine tuberculoma. AJNR, 1149–1150, 1987.Google Scholar

Copyright information

© Masson Italia Periodici 1989

Authors and Affiliations

  • Provinciali L. 
    • 1
  • Pesce M. Del 
    • 1
  • Censori B. 
    • 1
  • Pasquini U. 
    • 2
  1. 1.Istituto delle Malattie del Sistema NervosoUniversità di AnconaItaly
  2. 2.Servizio di Neuroradiologia U.S.L.12 di AnconaItaly

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