RESUMO
Central Nervous System Tuberculosis [CNSTB] continues to be a common problem world-wide and particularly in India. With the widespread availability of Magnetic Resonance Imaging [MRI], it is increasingly used for the diagnosis and follow up of CNSTB. This study presents a review of 50 cases of CNSTB seen in central India. Between 2006 and 2009, 50 cases of CNSTB [28 Spinal, 22 Cerebral] were diagnosed and followed up. MRI was performed using either a0.2Tor 1.5T unit using a standard protocol. Contrast study was needed in 32 cases. The diagnosis was later confirmed either by histopathological or microbiological examination in most cases and by a positive treatment response in some cases. All patients underwent routine radiograph of the chest to look for associated pulmonary tuberculosis, haematological tests and in some cases CT scan guided aspiration / biopsy and CSF analysis. There were 20 male and 30 female patients with age range of 4 to 65 years. Most common spinal lesion noted was the typical paradiscal involvement followed by skip lesion and posterior element lesion. The lesion was extradural in 19 and intradural in 3 cases. The most common cerebral lesion was meningitis followed by tuberculomas, abscess and obstructive hydrocephalus. Response to treatment was assessed using MRI in 30 cases. MRI has revolutionized the imaging of CNSTB. The diagnosis can be made with reasonable certainty, obviating the need for an invasive procedure both for diagnosis and treatment. This was confirmed by the resolution of brain and spinal cord pathological changes after anti-tubercular chemotherapy. MRI also allows for monitoring the response to treatment of patients with CNSTB. However in some cases confirmation of diagnosis by needle aspiration and histopathological analysis may be indicated when the imaging findings are not conclusive