eMedicine Specialties > Radiology > Brain/Spine

Tuberculosis, CNS: Follow-up

Author: Peter D Corr, MD, MB, ChB, FRCR, Professor of Radiology, United Arab Emirates University
Contributor Information and Disclosures

Updated: Dec 30, 2008

Intervention

Medicolegal Pitfalls

  • Failure to perform contrast-enhanced CT scanning or gadolinium-enhanced MRI if meningitis is suspected (Meningeal and cerebral involvement is easily missed without contrast enhancement.)

Special Concerns

  • The diagnosis of CNS TB can be easily missed in pregnant patients.
    • Precautions should be taken when CT scanning is used during pregnancy.
    • A lead apron should be used to protect the fetus from radiation.
    • MRI that does not involve radiation is probably the best method of investigation; however, the use of intravenously administered gadolinium-based contrast agents during pregnancy is not recommended.
  • In infants (in whom TBM is most common), follow-up examination can be performed by using brain ultrasonography rather than CT if the fontanel is patent. The use of ultrasonography reduces the patient's cumulative radiation dose.
 


More on Tuberculosis, CNS

Overview: Tuberculosis, CNS
Imaging: Tuberculosis, CNS
Follow-up: Tuberculosis, CNS
Multimedia: Tuberculosis, CNS
References
Further Reading

References

  1. Friedman LN, Williams MT, Singh TP, Frieden TR. Tuberculosis, AIDS, and death among substance abusers on welfare in New York City. N Engl J Med. Mar 28 1996;334(13):828-33. [Medline].

  2. Corbett EL, Watt CJ, Walker N, et al. The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med. May 12 2003;163(9):1009-21. [Medline].

  3. World Health Organization. Global Tuberculosis Control: Surveillance, Planning, Financing. Geneva: WHO Press; 2007. [Full Text].

  4. Rock RB, Olin M, Baker CA, Molitor TW, Peterson PK. Central nervous system tuberculosis: pathogenesis and clinical aspects. Clin Microbiol Rev. Apr 2008;21(2):243-61, table of contents. [Medline].

  5. Rafi W, Venkataswamy MM, Ravi V, et al. Rapid diagnosis of tuberculous meningitis: a comparative evaluation of in-house PCR assays involving three mycobacterial DNA sequences, IS6110, MPB-64 and 65 kDa antigen. J Neurol Sci. Jan 31 2007;252(2):163-8. [Medline].

  6. Srikanth SG, Taly AB, Nagarajan K, et al. Clinicoradiological features of tuberculous meningitis in patients over 50 years of age. J Neurol Neurosurg Psychiatry. May 2007;78(5):536-8. [Medline].

  7. Smith AB, Smirniotopoulos JG, Rushing EJ. From the archives of the AFIP: central nervous system infections associated with human immunodeficiency virus infection: radiologic-pathologic correlation. Radiographics. Nov-Dec 2008;28(7):2033-58. [Medline].

  8. Semlali S, El Kharras A, Mahi M, Hsaini Y, Benameur M, Aziz N, et al. [Imaging features of CNS tuberculosis]. J Radiol. Feb 2008;89(2):209-20. [Medline].

  9. Janse van Rensburg P, Andronikou S, van Toorn R, Pienaar M. Magnetic resonance imaging of miliary tuberculosis of the central nervous system in children with tuberculous meningitis. Pediatr Radiol. Dec 2008;38(12):1306-13. [Medline].

  10. Appenzeller S, Faria AV, Zanardi VA, Fernandes SR, Costallat LT, Cendes F. Vascular involvement of the central nervous system and systemic diseases: etiologies and MRI findings. Rheumatol Int. Oct 2008;28(12):1229-37. [Medline].

  11. Garg RK. Tuberculosis of the central nervous system. Postgrad Med J. Mar 1999;75(881):133-40. [Medline].

  12. Osborn AG. Diagnostic Neuroradiology. St Louis, Mo: Mosby; 1994.

  13. Shah GV. Central nervous system tuberculosis: imaging manifestations. Neuroimaging Clin N Am. May 2000;10(2):355-74. [Medline].

  14. Zimmerman RA, Gibby WA, Carmody RF, eds. Neuroimaging: Clinical and Physical Principles. New York, NY: Springer-Verlag; 1999.

Keywords

tuberculosis of the central nervous system, TB, Mycobacterium tuberculosis, cerebral tuberculosis, cerebral granulomas, tuberculomas, tuberculous granulomas, tuberculous abscesses, granulomatous meningitis, granulomatous infection, tuberculous meningitis, TBM

Contributor Information and Disclosures

Author

Peter D Corr, MD, MB, ChB, FRCR, Professor of Radiology, United Arab Emirates University
Peter D Corr, MD, MB, ChB, FRCR is a member of the following medical societies: American Roentgen Ray Society, International Skeletal Society, International Society for Magnetic Resonance in Medicine, Radiological Society of North America, Royal College of Radiologists, Royal College of Surgeons of Edinburgh, and South African Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Pamela W Schaefer, MD, Assistant Professor of Radiology, Harvard Medical School; Associate Director of Neuroradiology, Clinical Director of Magnetic Resonance Imaging, Department of Radiology, Massachusetts General Hospital
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

C Douglas Phillips, MD, Professor, Departments of Radiology, Neurosurgery, and Otolaryngology, University of Virginia Health Sciences Center
C Douglas Phillips, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Society of Head and Neck Radiology, American Society of Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Amirsys Royalty Consulting

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

James G Smirniotopoulos, MD, Professor of Radiology, Neurology, and Biomedical Informatics, Chairman, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences
James G Smirniotopoulos, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Head and Neck Radiology, American Society of Neuroradiology, American Society of Pediatric Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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