Central nervous system tuberculosis in Australia: a report of 22 cases.

Objective: To review the clinical features, treatment and outcome of patients with central nervous system (CNS) tuberculosis.

Design And Setting: A retrospective analysis of the case records of patients diagnosed as having CNS tuberculosis in a large Australian teaching hospital.

Patients: Twenty-two patients with CNS tuberculosis were identified between 1978 and 1989. Six patients (age range, 17-78 years) were Australian-born whites, seven patients (age range, 21-68 years) were overseas settlers in Australia and nine patients (age range, 14-56 years) were New Caledonians. The diagnoses included tuberculous meningitis, intracranial tuberculomas and intracranial tuberculous abscesses. These were confirmed by microbiology and/or histopathology in 16 patients and were presumptive in the remaining six.

Results: All patients were treated with antituberculous drugs and 14 received corticosteroids as well. Fourteen patients made a full recovery and two had mild residual neurological disability. Four patients died and two were left with severe residual disability. The neurological state of seven patients (all non-whites) deteriorated paradoxically after they started taking the antituberculous drugs.

Conclusions: The diagnosis of CNS tuberculosis may be difficult to make, so therapy based on a presumptive diagnosis will often be needed because of the poor outcome if treatment is delayed. Computed tomographic scanning helps the initial diagnosis and demonstrates the processes underlying paradoxical deterioration, which may occur in the face of adequate antituberculous treatment. Corticosteroids are effective in treating this uncommon complication.