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Pathology of Tuberculosis of the Nervous System (Tuberculous Meningitis, Tuberculoma, Tuberculous Abscess)

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Tuberculosis of the Central Nervous System

Abstract

Tuberculosis (TB) of the central nervous system (CNS) is a life-threatening manifestation of extrapulmonary TB. It is commonly a consequence of hematogenous dissemination of bacilli following a pulmonary infection. With the emergence of HIV, it is being increasingly acknowledged as a cause of neurological morbidity and mortality in the developed world as well. Neuro-TB may present as meningitis, tuberculoma, or tuberculous abscess. Thick gelatinous basal exudates are the pathological hallmark of the disease in tuberculous meningitis and lead to numerous complications. This chapter details the gross anatomic and microscopic alterations seen in these presentations of TB of CNS. Various differential diagnoses of these lesions are discussed, and an outline of diagnostic modalities available to the treating physician is provided.

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Abbreviations

ADA:

Adenosine deaminase

AFB:

Acid-fast bacilli

AIDS:

Acquired immunodeficiency syndrome

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

CSW:

Cerebral salt wasting

CT:

Computed tomography

CVST:

Cortical venous sinus thrombosis

HIV:

Human immunodeficiency virus

MAC:

Mycobacterium avium complex

MRI:

Magnetic resonance imaging

NAA:

Nucleic acid amplification assay

NTM:

Nontubercular mycobacteria

PCR:

Polymerase chain reaction

SIADH:

Syndrome of inappropriate antidiuretic hormone secretion

TB:

Tuberculosis

TBA:

Tuberculous brain abscess

TBM:

Tuberculous meningitis

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Authors and Affiliations

  1. Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, UP, India

    Kiran Preet Malhotra MD, DNB, PDCC

  2. Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, UP, India

    Dinkar Kulshreshtha MBBS, DM

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  1. Kiran Preet Malhotra MD, DNB, PDCC
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  2. Dinkar Kulshreshtha MBBS, DM
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Correspondence to Kiran Preet Malhotra MD, DNB, PDCC .

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Editors and Affiliations

  1. Adnan Menderes University, School of Medicine, Aydın, Turkey

    Mehmet Turgut

  2. Mohammed V University in Rabat, Avicenne Military Hospital of Marrakech, Rabat, Morocco

    Ali Akhaddar

  3. Hacettepe University, School of Medicine, Ankara, Turkey

    Ahmet T. Turgut

  4. King George Medical University, Lucknow, Uttar Pradesh, India

    Ravindra K. Garg

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Malhotra, K.P., Kulshreshtha, D. (2017). Pathology of Tuberculosis of the Nervous System (Tuberculous Meningitis, Tuberculoma, Tuberculous Abscess). In: Turgut, M., Akhaddar, A., Turgut, A., Garg, R. (eds) Tuberculosis of the Central Nervous System. Springer, Cham. https://doi.org/10.1007/978-3-319-50712-5_4

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  • DOI: https://doi.org/10.1007/978-3-319-50712-5_4

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