Neurological Manifestations of Tuberculosis Spinal Arachnoiditis & Polyradiculopathy: • Subacute onset of limb weakness, bladder/bowel dysfunction, muscle wasting, radicular pain, paresthesias • Imaging: diffuse enhancement of meninges in spinal cord and nerve roots Spinal Cord Tuberculoma: • Disseminated baccilemia leads to coalescing tubercles • Limb weakness, sensory abnormalities, bowel/bladder dysfunction • Imaging: ring-enhanced lesion Pott's Disease (Vertebral Spondylitis): • Paraplegia, bladder/bowel dysfunction, back pain • Imaging: gibbus deformity, vertebral narrowing and collapse Immune Reconstitution Inflammatory Syndrome (IRIS): • In HIV+, usually 4 weeks after starting antiretroviral therapy • Worsening of previous neurologic symptoms, fever, inccreased lymphadenopathy, pulmonary symptoms Intracranial Vasculopathy: • Usually is a complication of Tuberculous Meningitis • Include: vasculitis and infarction, vasospasm, thrombosis, or hemorrhagic stroke Tuberculous Abscess: • More bacilli than the tuberculoma (later stage) • Headache, fever, focal neurological deficits • Imaging: thick, multiloculated, contrast enhancement Brain Tuberculoma: • Papilledema, headache, seizures, focal neurological deficits • Imaging: surrounding edema and ring-enhancement lesion Tuberculous Encephalopathy: • Children with pulmonary TB • Many possible neurological symptoms • Caused by immune mechanisms and not direct infection • Imaging: cerebral edema, similar to ADEM Tuberculous Meningitis: • Fever, vomiting, apathy developing insidiously or abruptly • CN dysfunction: II/VI/VII • Hydrocephalus: due to increased CSF protein • Imaging: basilar meningeal enhancement, infarctions By Dr. Gabriela Figueiredo Pucci @gabifpucci @neudrawlogy #Neurological #Manifestations #Tuberculosis #diagnosis #differential #TB #neurology
