RESUMO
INTRODUCTION: Despite the resurgence of tuberculosis, partly due to HIV infection, central nervous system involvement remains rare, accounting for only 2 to 5% of all tuberculosis forms. PATIENTS ET METHOD: We report six cases of brain tuberculomas occurring in patients free of HIV infection and hospitalized between 2001 and 2006 in the internal medicine department of a Tunisian military hospital (Tunis). RESULTS: Four patients had an underlying defect. Headache, fever, consciousness disorders, deficit disorder or cerebellar syndrome are the main symptoms. Tuberculomas were multiple and disseminated in four cases and localized in the brain stem in two cases. Positive diagnosis could be established in two cases on the basis of the pathology results of a brain biopsy or detection of Mycobacterium tuberculosis in the cerebrospinal fluid; the diagnosis was presumptive in the other cases. Five patients recovered under antituberculosis treatment maintained on average 13 months (11 to 16 months). Steroid treatment was associated in five patients and tapered off for four to six weeks. One 78-year-old diabetic patient died in a context of cachexia with multiple organ failure.
Assuntos
Encefalopatias/diagnóstico , Tuberculoma/diagnóstico , Adulto , Idoso , Antituberculosos/uso terapêutico , Encefalopatias/tratamento farmacológico , Encefalopatias/mortalidade , Encefalopatias/patologia , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Tuberculoma/tratamento farmacológico , Tuberculoma/mortalidade , Tuberculoma/patologiaRESUMO
Two hundred and fifteen case histories were studied to clarify causes of death in patients with active tuberculosis who had died from it. Males accounted for the largest proportion (86%) (n = 185). Patients above 50 years were 63.3% (n = 136). Two thirds were patients with restrictive tuberculosis without destruction and bacterial isolation. A hundred and fifty (70%) and 30% patients died from somatic diseases and other causes (sequels to alcohol abuse, violent death, suicide, etc.), respectively. Of the somatic diseases, cardiovascular diseases head the list, cancer ranks next to it, nonspecific respiratory diseases occupy the third place.
