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.
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References
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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].
World Health Organization. Global Tuberculosis Control: Surveillance, Planning, Financing. Geneva: WHO Press; 2007. [Full Text].
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].
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].
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].
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].
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].
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].
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].
Garg RK. Tuberculosis of the central nervous system. Postgrad Med J. Mar 1999;75(881):133-40. [Medline].
Osborn AG. Diagnostic Neuroradiology. St Louis, Mo: Mosby; 1994.
Shah GV. Central nervous system tuberculosis: imaging manifestations. Neuroimaging Clin N Am. May 2000;10(2):355-74. [Medline].
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
Follow-up: Tuberculosis, CNS