Page 15 - Read Online

Editorial

Diagnosis and therapy of rare central nervous

system infections

Xiao‑Kun Qi
Department of Neurology, Navy General Hospital of PLA, Beijing 100048, China.

INTRODUCTION The clinical symptoms of tuberculous meningitis
are relatively obvious. Among them, headache and
Central nervous system (CNS) infection is one of fever are the most common symptoms. Besides, the
the most disabling and deadly diseases worldwide. symptoms of tuberculous meningitis, tuberculous
According to the World Health Organization, there meningoencephalitis can also show signs of the brain
were about 700,000 cases of meningitis in 2004, with parenchymal involvement, insanity or cognitive
approximately 340,000 related deaths. CNS infection impairment, and signs of specific area damage, such as
[1]
includes infection with bacteria, viruses, fungi and cranial nerve palsies and epilepsy. Typical characteristic
parasites. In most cases, it is difficult for radiologists cerebrospinal fluid (CSF) findings of CNS tuberculosis
and clinicians to make a definitive diagnosis. Therefore, include the following: total white cell counts
we reviewed all the relevant domestic and international increase (usually [50–200] ×10 /L, 1000 ×10 /L in
6
6
clinical research development. very few cases), and neutrophil predominance presents
very early, with lymphocytic-predominant pleocytosis
DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS OF developing later; an elevated CSF protein, typically
CENTRAL NERVOUS SYSTEM MYCOBACTERIUM 1–2 g/L; and a significant reduction in sugar and chloride
TUBERCULOSIS INFECTION levels. Tuberculous meningoencephalitis often occurs
with atypical clinical features, sometimes with the acute
Central nervous system tuberculosis, accounting for or chronic onset, manifested by fever, neurological
5%–10% of all types of Mycobacterium tuberculosis (MTB) symptoms, and nondiagnostic CSF findings. Above
infection, is an extra-pulmonary tuberculosis leading all, at present, we need to make a comprehensive
to various complications and high rates of morbidity judgment-based on both clinical features and image
and mortality. CNS tuberculotic patients may show data of the patients. Meningeal enhancement is usually
[2]
either general manifestations caused by toxins from visible at the skull base, lateral fissure, optic chiasma, and
N/med tuberculosis bacilli, such as low-grade fever, night brain stem. When CSF protein is increased significantly,
sweats and headache, or the symptoms of encephalitis computed tomography (CT) images may additionally
and meningitis. Major complications of tuberculous show enhancement of the suprasellar cistern, optic
meningitis include hydrocephalus, tuberculous vasculitis chiasma cistern, and prepontile cistern due to exudative
and cranial nerve palsies. Intracranial tuberculosis reaction. Magnetic resonance imaging (MRI) offers a
includes tuberculoma tuberculosis, tuberculous abscess, significant advantage for diagnosis of CNS tuberculosis,
tuberculosis encephalitis, and encephalopathy. [3] especially when incorporating magnetization transfer
imaging. [3]
Access this article online
Quick Response Code: Nowadays, the typical fever symptom in tuberculoma
Website: patients is rare, and CSF changes may not be typical
www.nnjournal.net
either. The only abnormal finding is the presence of
DOI: granulomas in brain CT and MRI images, with nodular
10.4103/2347-8659.135568 and rim enhancement and without obvious meningeal
enhancement. CNS tuberculoma must sometimes be

Corresponding Author: Prof. Xiao‑Kun Qi, Department of Neurology, Navy General Hospital of PLA, No. 6 Fucheng Road,
Beijing 100048, China. E‑mail: bjqxk@sina.com

8 Neuroimmunol Neuroinflammation | Volume 1 | Issue 1 | June 2014