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Brainstem Tuberculosis

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Tuberculosis of the Central Nervous System

Abstract

Brainstem tuberculosis (TB) is a rare and devastating form of TB of the central nervous system (CNS) and diagnostically challenging. It may occur as tuberculoma, abscess, or rhombencephalic leptomeningitis. It can develop as isolated lesion in the brainstem or may occur in association with TB in other parts of the brain or as a part of generalized tuberculous meningitis. Clinical features are nonspecific for TB of CNS or brainstem lesions. Hematological and cerebrospinal fluid findings are nonspecific for TB of CNS, and radiological findings can simulate with other brainstem lesions like glioma, lymphoma, metastasis, cysticercosis, and pyogenic bacterial abscess. Treatment is mostly medical with anti-TB chemotherapy and with or without corticosteroid therapy. Larger abscesses or large tuberculoma with mass effect or chronic lesions that does not respond to chemotherapy alone may require surgery.

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Abbreviations

ADA:

Adenosine deaminase

AFB:

Acid-fast bacillus

BCG:

Bacillus Calmette-Guérin

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

CT:

Computed tomography

EMB:

Ethambutol

HIV:

Human immunodeficiency virus

IICP:

Increased intracranial pressure

INH :

Isoniazid

MRI:

Magnetic resonance imaging

MRS:

Magnetic resonance spectroscopy

NAA:

Nucleic acid amplification

NHL:

Non-Hodgkin’s lymphoma

PCR:

Polymerase chain reaction

PZA:

Pyrazinamide

RIF:

Rifampicin

SOT:

Solid organ transplantation

TB:

Tuberculosis

TBA:

Tuberculous brain abscess

TBM:

Tuberculous meningitis

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, National Institute of Neurosciences and Hospital, Sher-e-Bangla Nagar, Dhaka, 1207, Bangladesh

    Md Zahed Hossain FCPS, MS & Forhad H. Chowdhury FCPS, MS

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

    Ali Akhaddar MD, IFAANS

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

    Ahmet T. Turgut MD

Authors
  1. Md Zahed Hossain FCPS, MS
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  2. Ali Akhaddar MD, IFAANS
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  3. Ahmet T. Turgut MD
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  4. Forhad H. Chowdhury FCPS, MS
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Correspondence to Md Zahed Hossain FCPS, MS .

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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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Hossain, M.Z., Akhaddar, A., Turgut, A.T., Chowdhury, F.H. (2017). Brainstem Tuberculosis. 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_9

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