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Tuberculosis of the central nervous system in children

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Abstract

Background

Central nervous system tuberculosis (CNS TB) in children is still a socioeconomic problem in developing countries. It has varied manifestations, symptoms are nonspecific, diagnosis can be challenging, and treatment may be difficult. It is often missed or overlooked. Among the various pathological entities, tuberculous meningitis is the most common and devastating manifestation. The resultant vasculitis, infarction, and hydrocephalus can be life-threatening. It can have grave cognitive, intellectual, and endocrine sequelae if not treated in time resulting in handicap, especially in resource constraint countries. Early diagnosis and treatment of tuberculous meningitis is the single most important factor determining outcome. Tuberculous hydrocephalus needs to be recognized early, and cerebrospinal fluid diversion procedure needs to be performed in adequate time to prevent morbidity or mortality in some cases. Tuberculous pachymeningitis and arachnoiditis are rare in children. Tuberculous abscess can mimic pyogenic abscess and requires high index of suspicion. Calvarial tuberculosis is seen in children and responds well to antituberculous chemotherapy. Drug-resistant tuberculosis is a formidable problem, and alternate chemotherapy should be promptly instituted.

Aim

The pathogenesis, clinical features, diagnosis, and management of central nervous system tuberculosis in children are summarized.

Conclusion

Heightened clinical suspicion, early diagnosis, appropriate antituberculous treatment, and surgery in relevant situation are essential for a gratifying outcome and preventing complications.

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References

  1. Vadivelu S, Effendi S, Starke JR, Luerssen TG, Jea A (2013) A review of the neurological and neurosurgical implications of tuberculosis in children. Clin Pediatr (Phila) Jul 10

  2. Be NA, Kim KS, Bishai WR, Jain SK (2009) Pathogenesis of central nervous system tuberculosis. Curr Mol Med 9(2):94–99

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Jain AK, Sreenivasan R, Mukunth R, Dhammi IK (2014) Tubercular spondylitis in children. Indian J Orthop 48(2):136–144

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hu J, Li D, Kang Y, Pang X, Wu T, Duan C, Cao Y (2014) Active thoracic and lumbar spinal tuberculosis in children with kyphotic deformity treated by one-stage posterior instrumentation combined anterior debridement: preliminary study. Eur J Orthop Surg Traumatol 24(Suppl 1):S221–S229

    Article  PubMed  Google Scholar 

  5. Varatharajah S, Charles YP, Buy X, Walter A, Steib JP (2014) Update on the surgical management of Pott’s disease. Orthop Traumatol Surg Res 100(2):229–235

    Article  PubMed  CAS  Google Scholar 

  6. Waecker NJ (2002) Tuberculous meningitis in children. Curr Treat Options Neurol 4(3):249–257

    Article  PubMed  Google Scholar 

  7. Parihar V, Yadav YR, Sharma D (2009) Giant extra-axial posterior fossa tuberculoma in a three-year-old child. Neurol India 57(2):218–220

    Article  PubMed  Google Scholar 

  8. Figaji AA, Sandler SI, Fieggen AG, Le Roux PD, Peter JC, Argent AC (2008) Continuous monitoring and intervention for cerebral ischemia in tuberculous meningitis. Pediatr Crit Care Med 9(4):e25–e30

    Article  PubMed  Google Scholar 

  9. Bhagwati SN, Singhal BS (1970) Raised intracranial pressure as a mode of presentation in tuberculous meningitis. Neurol India 18(2):116–119

    PubMed  CAS  Google Scholar 

  10. Dastur H (1983) Diagnosis and neurosurgical treatment of tuberculous disease of the CNS. Neurosurg Rev 6(3):111–117

    Article  PubMed  CAS  Google Scholar 

  11. Dastur HM (1972) A tuberculoma review with some personal experiences. I. Brain. Neurol India 20(3):111–1126

    PubMed  CAS  Google Scholar 

  12. Bhagwati SN, Parulekar GD (1986) Management of intracranial tuberculoma in children. Childs Nerv Syst 2(1):32–34

    Article  PubMed  CAS  Google Scholar 

  13. Figaji AA, Fieggen AG (2010) The neurosurgical and acute care management of tuberculous meningitis: evidence and current practice. Tuberculosis (Edinb) 90(6):393–400

    Article  Google Scholar 

  14. Schoeman J, Wait J, Burger M, van Zyl F, Fertig G, van Rensburg AJ, Springer P, Donald P (2002) Long-term follow up of childhood tuberculous meningitis. Dev Med Child Neurol 44(8):522–526

    Article  PubMed  CAS  Google Scholar 

  15. Ramzan A, Nayil K, Asimi R, Wani A, Makhdoomi R, Jain A (2013) Childhood tubercular meningitis: an institutional experience and analysis of predictors of outcome. Pediatr Neurol 48(1):30–35

    Article  PubMed  Google Scholar 

  16. Przybojewski S, Andronikou S, Wilmshurst J (2006) Objective CT criteria to determine the presence of abnormal basal enhancement in children with suspicious tuberculous meningitis. Pediatr Radiol 36:687–696

    Article  PubMed  Google Scholar 

  17. Pienaar M, Andronikou S, van Toorn R (2009) MRI to demonstrate diagnostic features and complications of TBM not seen with CT. Childs Nerv Syst 25(8):941–947

    Article  PubMed  Google Scholar 

  18. Chatterjee S, Saini J, Kesavadas C, Arvinda HR, Jolappara M, Gupta AK (2010) Differentiation of tubercular infection and metastasis presenting as ring enhancing lesion by diffusion and perfusion magnetic resonance imaging. J Neuroradiol 37(3):167–171

    Article  PubMed  CAS  Google Scholar 

  19. Andronikou S, vanToorn R, Boerhout E (2009) MR imaging of the posterior hypophysis in children with tuberculous meningitis. Eur Radiol 19(9):2249–2254

    Article  PubMed  Google Scholar 

  20. Gupta R (2002) Magnetization transfer MR imaging in central nervous system infections. Indian J Radiol Imaging 12:51–58

    Google Scholar 

  21. Dastur HM (1972) A tuberculoma review with some personal experiences. II. Spinal cord and its coverings. Neurol India 20(3):127–131

    PubMed  CAS  Google Scholar 

  22. Sivakumar V, Rajshekhar V, Chandy MJ (1994) Management of neurosurgical patients with hyponatremia and natriuresis. Neurosurgery 34:269–274

    Article  PubMed  CAS  Google Scholar 

  23. Sriramchandra D, Rajshekhar V, Chandy MJ (1997) Validation study of a central venous pressure based protocol for the management of neurosurgical patients with hyponatremia and natriuresis. Neurosurgery 40:312–316

    Article  Google Scholar 

  24. Nagotkar L, Shanbag P, Dasarwar N (2008) Cerebral salt wasting syndrome following neurosurgical intervention in tuberculous meningitis. Indian Pediatr 45(7):598–601

    PubMed  CAS  Google Scholar 

  25. Palur R, Rajshekhar V, Chandy MJ, Joseph T, Abraham J (1991) Shunt surgery for hydrocephalus in tuberculous meningitis: a long-term follow-up study. J Neurosurg 174(1):64–69

    Article  Google Scholar 

  26. Lamprecht D, Schoeman J, Donald P, Hartzenberg H (2001) Ventriculoperitoneal shunting in childhood tuberculous meningitis. Br J Neurosurg 15(2):119–125

    Article  PubMed  CAS  Google Scholar 

  27. Peng J, Deng X, He F, Omran A, Zhang C, Yin F, Liu J (2012) Role of ventriculoperitoneal shunt surgery in grade IV tubercular meningitis with hydrocephalus. Childs Nerv Syst 28(2):209–215

    Article  PubMed  CAS  Google Scholar 

  28. Bhagwati SN (1971) Ventriculoatrial shunt in tuberculous meningitis with hydrocephalus. J Neurosurg 35(3):309–313

    Article  PubMed  CAS  Google Scholar 

  29. Agarwal N, Shukla RM, Agarwal D, Gupta K, Luthra R, Gupta J, Jain S (2017) Pediatric ventriculoperitoneal shunts and their complications: an analysis. J Indian Assoc Pediatr Surg 22(3):155–157

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sil K, Chatterjee S (2008) Shunting in tuberculous meningitis: a neurosurgeon’s nightmare. Childs Nerv Syst 24(9):1029–1032

    Article  PubMed  Google Scholar 

  31. Husain M, Jha DK, Rastogi M, Husain N, Gupta RK (2005) Role of neuroendoscopy in the management of patients with tuberculous meningitis hydrocephalus. Neurosurg Rev 28(4):278–283

    Article  PubMed  Google Scholar 

  32. Chugh A, Husain M, Gupta RK, Ojha BK, Chandra A, Rastogi M (2009) Surgical outcome of tuberculous meningitis hydrocephalus treated by endoscopic third ventriculostomy: prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy. J Neurosurg Pediatr 3(5):371–377

    Article  PubMed  Google Scholar 

  33. Siomin V, Constantini S (2003) Endoscopic third ventriculostomy in tuberculous meningitis. Childs Nerv Syst 19(5–6):269

    Article  PubMed  Google Scholar 

  34. Figaji AA, Fieggen AG, Peter JC (2003) Endoscopic third ventriculostomy in tuberculous meningitis. Childs Nerv Syst 19(4):217–225

    PubMed  CAS  Google Scholar 

  35. Figaji AA, Fieggen AG (2013) Endoscopic challenges and applications in tuberculous meningitis. World Neurosurg 79(2 Suppl):S24 e9–14

    PubMed  Google Scholar 

  36. Bhagwati S, Mehta N, Shah S (2010) Use of endoscopic third ventriculostomy in hydrocephalus of tubercular origin. Childs Nerv Syst 26(12):1675–1682

    Article  PubMed  Google Scholar 

  37. Bhagwati SN, George K (1986) Use of intrathecal hyaluronidase in the management of tuberculous meningitis with hydrocephalus. Childs Nerv Syst 2(1):20–25

    Article  PubMed  CAS  Google Scholar 

  38. vanToorn R, Solomons R (2014) Update on the diagnosis and management of tuberculous meningitis in children. Semin Pediatr Neurol 21(1):12–18

    Article  Google Scholar 

  39. Shobha N, Mahadevan A, Taly AB, Sinha S, Srikanth SG, Satish S, Nandagopal R, Arunodaya GR, Chandramouli BA, Shankar SK (2008) Hypertrophic cranial pachymeningitis in countries endemic for tuberculosis: diagnostic and therapeutic dilemmas. J ClinNeurosci 418–427

  40. Senapati SB, Mishra SS, Das S, Parida DK, Satapathy MC (2014) Craniocervical tuberculous hypertrophic pachymeningitis. Surg Neurol Int 5:52

    Article  PubMed  PubMed Central  Google Scholar 

  41. Chee RI, Dinkin MJ (2016) Tuberculous optochiasmatic arachnoiditis and vision loss. Neurology 87(17):1845

    Article  PubMed  Google Scholar 

  42. Lee JS, Song GS, Son DW (2017) Surgical management of syringomyelia associated with spinal adhesive arachnoiditis, a late complication of tuberculous meningitis: a case report. Korean J Neurotrauma 13(1):34–38

    Article  PubMed  PubMed Central  Google Scholar 

  43. Schoeman J, Malan G, van Toorn R, Springer P, Parker F, Booysen J (2009) Home-based treatment of childhood neurotuberculosis. J Trop Pediatr 55(3):149–154

    Article  PubMed  Google Scholar 

  44. Kondety SK, Chatterjee S (2016) Acquired Chiari malformation secondary to tuberculous arachnoiditis of the lumbar spine. Neurol India 64(5):1066–1068

    Article  PubMed  Google Scholar 

  45. van Toorn R, Schoeman JF, Donald P (2006) Brainstem tuberculoma presenting as eight-and-a-half syndrome. Eur J PaediatrNeurol 10(1):41–44

    Google Scholar 

  46. Jain R, Kumar (2001) Suprasellar tuberculoma presenting with diabetes insipidus and hypothyroidism—a case report. Neurol India 49(3):314–316

    PubMed  CAS  Google Scholar 

  47. Chitre PS, Tullu MS, Sawant HV, Ghildiyal RG (2009) Co-occurrence of intracerebral tuberculoma with lumbar intramedullary tuberculoma. J Child Neurol 24(5):606–609

    Article  PubMed  Google Scholar 

  48. Dastur HM, Shah MD (1968) Intramedullary tuberculoma of the spinal cord. Indian Pediatr 5(10):468–471

    PubMed  CAS  Google Scholar 

  49. Kumar R, Kasliwal MK, Srivastava R, Sharma BS (2007) Tuberculoma presenting as an intradural extramedullary lesion. Pediatr Neurosurg 43(6):541–543

    Article  PubMed  Google Scholar 

  50. Selvapandian S, Rajshekhar V, Chandy MJ, Idikula J (1994) Predictive value of computed tomography-based diagnosis of intracranial tuberculomas. Neurosurgery 35(5):845–850

    Article  PubMed  CAS  Google Scholar 

  51. Kumar R, Prakash M, Jha S (2006) Paradoxical response to chemotherapy in neurotuberculosis. Pediatr Neurosurg 42(4):214–222

    Article  PubMed  Google Scholar 

  52. Perez-Alvarez F, Serra C, Mayol L, Liarte A (2008) Unusual central nervous system tuberculosis debut in children: stroke. Childs Nerv Syst 24(5):539–540

    Article  PubMed  CAS  Google Scholar 

  53. Poonnoose SI, Rajshekhar V (2003) Rate of resolution of histologically verified intracranial tuberculomas. Neurosurgery 53(4):873–878

    Article  PubMed  Google Scholar 

  54. Rajshekhar V, Chandy MJ (1993) CT guided stereotactic surgery in the management of intracranial tuberculomas. Br J Neurosurg 7:665–671

    Article  PubMed  CAS  Google Scholar 

  55. Andronikou S, Greyling PJ (2009) Devastating yet treatable complication of tuberculous meningitis: the resistant TB abscess. Childs Nerv Syst 25(9):1105–1106

    Article  PubMed  Google Scholar 

  56. Abraham R, Kumar S, Scott JX, Agarwal I (2009) Tuberculous brain abscess in a child with tetralogy of Fallot. Neurol India 57(2):217–218

    Article  PubMed  Google Scholar 

  57. Muzumdar D, Balasubramaniam S, Melkundi S (2009) Tuberculous temporal brain abscess mimicking otogenic pyogenic abscess. Pediatr Neurosurg 45(3):220–224

    Article  PubMed  CAS  Google Scholar 

  58. Chakraborti S, Mahadevan A, Govindan A, Nagarathna S, Santosh V, Yasha TC, Devi BI, Chandramouli BA, Kovoor JM, Chandramuki A, Shankar SK (2009) Clinicopathological study of tuberculous brain abscess. Pathol Res Pract 205(12):815–822

    Article  PubMed  Google Scholar 

  59. Kumar R, Pandey CK, Bose N, Sahay S (2002) Tuberculous brain abscess: clinical presentation, pathophysiology and treatment (in children). Childs Nerv Syst 18(3–4):118–123

    Article  PubMed  Google Scholar 

  60. Diyora B, Kumar R, Modgi R, Sharma A (2009) Calvarial tuberculosis: a report of eleven patients. Neurol India 57(5):607–612

    Article  PubMed  Google Scholar 

  61. Ramdurg SR, Gupta DK, Suri A, Sharma BS, Mahapatra AK (2010) Calvarial tuberculosis: uncommon manifestation of common disease—a series of 21 cases. Br J Neurosurg 24(5):572–577

    Article  PubMed  Google Scholar 

  62. Jadhav RN, Palande DA (1999) Calvarial tuberculosis. Neurosurgery 45(6):1345–1349

    Article  PubMed  CAS  Google Scholar 

  63. Gupta PK, Kolluri VR, Chandramouli BA, Venkataramana NK, Das BS (1989) Calvarial tuberculosis: a report of two cases. Neurosurgery 25(5):830–833

    Article  PubMed  CAS  Google Scholar 

  64. Singh G, Kumar S, Singh DP, Verma V, Mohammad A (2014) A rare case of primary tuberculous osteomyelitis of skull vault. Indian J Tuberc 61(1):79–83

    PubMed  Google Scholar 

  65. García-García C, Ibarra V, Azcona-Gutiérrez JM, Oteo JA (2013) Calvarial tuberculosis with parenchymal involvement. Travel Med Infect Dis 11(5):329–331

    Article  PubMed  Google Scholar 

  66. Dawar P, Gupta DK, Sharma BS, Jyakumar A, Gamanagatti S (2013) Extensive calvarial tuberculosis presenting as exophytic ulcerated growth on scalp in an infant: an interesting case report with review of literature. Childs NervSyst. 29(7):1215–1218

    Article  Google Scholar 

  67. Raut AA, Nagar AM, Muzumdar D, Chawla AJ, NarlawarRS FS, Bhatgadde VL (2004) Imaging features of calvarial tuberculosis: a study of 42 cases. AJNR Am J Neuroradiol 25(3):409–414

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, King Edward VII Memorial Hospital, Parel, Mumbai, 400012, India

    Dattatraya Muzumdar

  2. Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India

    Rajshekhar Vedantam

  3. Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Marine Lines, Mumbai, India

    Deopujari Chandrashekhar

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  1. Dattatraya Muzumdar
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  2. Rajshekhar Vedantam
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  3. Deopujari Chandrashekhar
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Correspondence to Dattatraya Muzumdar.

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Muzumdar, D., Vedantam, R. & Chandrashekhar, D. Tuberculosis of the central nervous system in children. Childs Nerv Syst 34, 1925–1935 (2018). https://doi.org/10.1007/s00381-018-3884-9

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