Difficultés diagnostiques de la tuberculose cérébrale / Diagnostic difficulties of cerebral tuberculosis

La tuberculose est une des maladies infectieuses les plus répandues dans le monde .Elle représente un problème de santé publique majeur dans les pays en voie de développe ment, y compris l'Algérie . À l'échelle mondiale et parmi tous les cas de tuberculose, l'OMS rapporte 14 % de tuberculose extra-pulmonaire (TEP) sans atteinte pulmonaire concomitante. Dans notre pays et durant ces dernières années, une recrudescence de la tuberculose extrapulmonaire a été observée. L'objectif de cet article était de présenter un cas atypique de tuberculose cérébrale dont le diagnostic a été tardif, posé par l'examen anatomopathologique avec une revue de la littérature. C'est le cas d'une jeune patiente hospitalisée dans le cadre de l'urgence pour un syn drome d'hypertension intracrânienne avec troubles neurologiques. La tomodensitomé trie cérébrale a objectivé de multiples localisations cérébrales avec une hydrocéphalie active. Le bilan d'extension était sans anomalie. La patiente avait bénéficié d'une inter vention chirurgicale, les suites opératoires ont été favorables. L'examen anatomo-pa thologique était en faveur d'une lésion inflammatoire spécifique granulomateuse faite de larges plages de nécrose caséeuse. La patiente a répondu au traitement antituber culeux. Le problème diagnosticque et les résultats seront discutés avec une revue de la littéra ture. La tuberculose cérébrale est une forme rare de la tuberculose extra-pulmonaire. Le tableau clinique ainsi que la neuro-imagerie (TDM, IRM) sont atypiques. Le diagnostic était postopératoire, reposant sur l'examen anatomopathologique. Le pronostic dépend de la précocité du diagnostic, du siège de la lésion et de la réponse au traitement antituberculeux.

Tuberculosis is one of the most widespread infectious diseases in the world. It constitutes a major public health problem, especially in developing countries, including Algeria. Globally and among all tuberculosis cases, WHO reports 14% extra-pulmonary tuberculosis (EPT) without concomitant pulmonary involvement. In our country and in recent years, an upsurge in extrapulmonary tuberculosis has been observed. The objective of this article was to present an atypical case of cerebral tuberculosis whose diagnosis was late, made by anatomopathological examination with a review of the literature. We report the case of a young patient hospitalized in emergency for an intracranial hypertension syndrome with neurological disorders. Cerebral computed tomography revealed multiple brain locations with active hydrocephalus. The extension assessment was without anomaly. The patient underwent a surgical intervention, the operative consequences were favorable. The pathological examination was in favor of a specific inflammatory granulomatous lesion made up of large areas of caseous necrosis. The patient was cured under anti-tuberculosis treatment. The diagnostic problem and the results will be discussed with a review of the literature. Cerebral tuberculosis is a rare form of extrapulmonary tuberculosis. The clinic as well as the neuroimaging (CT, MRI) are atypical. The diagnosis is postoperative, based on the pathological examination. The prognosis depends on the early diagnosis, the site of the lesion and the response to anti-tuberculosis treatment.

Tuberculosis cerebral sin meningitis en un niño inmunocompetente / Cerebral tuberculosis without meningitis in a immunocompetent child

Resumen La tuberculosis (TBC) cerebral o tuberculoma(s) sin meningitis es una enfermedad poco frecuente y de alta morbimortalidad. Presentamos el caso clínico de un lactante de 11 meses, previamente sano, que consultó por fiebre prolongada y síntomas neurológicos. La RM de encéfalo mostró múltiples imágenes micronodulares e hidrocefalia. El estudio de LCR para bacterias, hongos y micobacterias fue negativo. Se prescribió terapia empírica como una meningoencefalitis subaguda y tratamiento antituberculoso tetraconjugado y corticoesteroides. La confirmación del diagnóstico de TBC cerebral se realizó por biopsia de la lesión, con presencia de inflamación granulomatosa crónica necrosante y bacilos ácido-alcohol resistentes. Se enfatiza la importancia de considerar esta presentación de TBC en niños, y la necesidad de la búsqueda exhaustiva del agente etiológico en diferentes líquidos y tejidos, aun por métodos invasores.

Cerebral tuberculosis TB (tuberculomas) without meningitis is an uncommon disease with a high morbidity and mortality. We report on a case that illustrates the complexity of this clinical presentation. An 11 month old, previously healthy male infant was brought to the clinic due to fever present during the last 1.5 months, associated with loss of neurodevelopmental goals and signs of endocranial hypertension. CT scan of the skull revealed dilatation of the ventricular system with transependimary edema; MRI showed multiple intra- and extra-axial micronodular images and hydrocephalus. Studies of CSF (cyto-chemical analysis, staining, culture for aerobes, fungi, mycobacteria, and molecular tests for TB were negative). Empirical management for subacute meningoencephalitis was prescribed complemented with tetraconjugated treatment for TB and steroids. As there was no microbiological isolation, biopsy of a cerebellar lesion was performed, which revealed chronic necrotizing granulomatous inflammation and acid-alcohol resistant bacilli. The diagnosis of cerebral TB without meningeal involvement was confirmed. The objective of the present report is to emphasize the importance of considering this presentation of TB in children, to remark the need of exhaustive search for the etiologic agent by obtaining samples of the different fluids and tissues even if it implies recurring to invasive methods.

Clinical application of DTI and MRS in the diagnosis of AIDS-related cerebral tuberculosis / 实用放射学杂志

Objective To investigate the clinical diagnostic values of quantitative DTI and MRS in AIDS-related cerebral tuberculosis. Methods 17 cases confirmed with AIDS and brain tuberculosis,16 volunteers were recruited to perform routine MRI,DTI and MRS sequences. Morphological characteristics of lesions were observed.ADC,FA,rADC,rFA,NAA/Cho,NAA/Cr and Cho/Cr of the lesions solid areas,edematous areas,normal areas and contralateral corresponding normal areas were measured and their variances in different areas were analyzed. Results Significant differences of the values were observed among the three regions of AIDS-related brain tuberculosis,the results of multiple comparisons between the three areas had statistical significances (P <0.05)excepted NAA/Cr between edematous and contralateral areas.ADC,FA,rADC,rFA,NAA/Cho,NAA/Cr on solid areas were lower than that on edematous areas,Cho/Cr on solid areas was higher than that on other two areas.The diagnostic efficiency of rFA value to distinguish solid and edematous areas was the highest by ROC analysis(P <0.05).The normal areas of the two groups had statistical significances(P <0.05)excepted Cho/Cr.Conclusion DTI is valuable to display the lesions micro-structure changes and MRS can reflect the early pathology metabolites changes of AIDS-related tuberculosis.

Miliary Tuberculosis Involving the Central Nervous System

In recent times, central nervous system(CNS) tuberculosis has been rare and the prevalence of the focal form, the tuberculoma, varies from 1 per 20 to 1 per 1000. CNS tuberculosis occurs as a result of hematogenous sparead from a primary focus, mostly pulmonary tuberculosis. It can be diffuse exudative leptomeningitis or a localized tuberculoma; the former is more common. We report a case of military cerebral tuberculosis in a 24-year-old female who had been having headaches for 4 months. Magnetic resonance imaging showed numerous small round Gadolinium-enhanced supratentorial and infratentorial lesions scattered throughtout the brain. Histologic examination confirmed well-defined tuberculous granulomas with central caseous necrosis in open biopsy, containing several acid-fast bacilli, the patient was treated with isoniazid, rifampin, ethambutol, pyrazinamide in combination with prednisolone.

Dynamic study of cerebral spinal fluid markers in patients with tuberculous meningitis / 重庆医科大学学报

Objective:To discuss the value for earlier diagnosis and curative effect evaluation of tuberculosis meningitis(TBM)by detecting the cerebrospinal fluid(CSF)routine,biochemistry and cytology check.Methods:Dynamic Analysis of cerebrospinal fluid routine,biochemistry and cytology variation have been performed on 80 cases with TBM between prior-treatment and post-treatment.Results:There is a obviously rise performed in the cerebrospinal fluid for the pressure,biochemistry index singularity ratio and neutrophil proportion prior treatment,while a progressive decline was observed in post treatment with a significant difference.The typical TBM in forepart showed intermix cytology reaction which had most granulocytes.During the middle period of the treatment,granulocytes reduced,more over immune cells and active hyaline leukocytes increased.During the later period of the treatment,active lymphocytes reaction was the most obvious.Cerebrospinal fluid cytology was back to normal when TBM had been cured.Conclusion:The cerebrospinal fluid cytology check is a significant index in earlier diagnosis of TBM;Dynamic observation on cerebrospinal fluid cytology is helpful for earlier diagnosis of TBM.Furthermore the method has some value in judging the prognosis of the patients suffened TBM.