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Tuberculosis

Brain tuberculosis

07/18/2008

Question:

My sister was not feeling well from few days. Then she got a swelling on her forehead and some small boils on her legs. So doctors said that it`s a blood clot on forehead and they operated it by taking out the dirty water from that boil. After one week she started vomiting and she had a fever, bad headache and unconsciousness. Now she is in ICU and CT scan and MRI shows 12 rings in her brain. Doctors are saying its brain TB (tuberculoma). Doctors have started the treatment through medicine. She seems in critical condition. I just want some infomation: Is it curable and how? Will medicines can cure her and how long it will take? Thanks.

Answer:

This is obviously a complicated case. There are several infections that can cause ring lesions in the brain. These can include tuberculosis (TB), bacterial abscess, fungal infections, parasitic infections, and some non-infectious causes. I am not sure how the diagnosis was made or what caused the boils on the forehead and legs. But we will only be discussing TB infection of the brain.

TB lesions in the brain are rare. Tuberculomas are granulomas in the brain. Granulomas are localized noncancerous nodular inflammatory sites of the tissue that contain TB bacteria. The body is usually able to fight the bacteria to stop them from growing and wall them off in a granuloma. In people who have been exposed to TB, granulomas can be found in different parts of the body such as the lung or brain. Patients with tuberculomas usually present with symptoms over a longer time, over several months. Symptoms include headache, fever, weight loss, weakness, nausea, vomiting, and seizures.

Sometimes the TB bacteria inside the tuberculomas can become active (perhaps the patient has developed another disease that has weakened the immune system) and begin to multiply and form TB abscesses which are filled with pus. Patients with TB abscesses usually present with more recent symptoms that include headache, seizures, confusion, and sometimes even inability to move the arms or legs.

It can be difficult to diagnose TB in the brain. CT scan and MRI are useful in showing the abscesses consistent with TB. However, a definitive diagnosis requires some tissue for staining and getting cultures. Some patients may have TB in the brain and TB in the lung at the same time. In this case, it might be easier to try and collect samples from the lung for culture and do drug testing to see which TB medicines work the best.

Treatment for TB of the brain is essentially the same as that for TB in the lungs but the duration is longer. It is curable and with TB treatment, symptoms and the brain lesions should improve.

For more information:

Go to the Tuberculosis health topic, where you can:

Response by:

Shu-Hua   Wang, MD, MPH&TM Shu-Hua Wang, MD, MPH&TM
Clinical Assistant Professor of Infectious Diseases
Clinical Assistant Professor of The Division of Epidemiology
College of Medicine
The Ohio State University

Larry S Schlesinger, MD Larry S Schlesinger, MD
Professor:
Molecular Virology, Immunology and Medical Genetics
Microbiology Administration
Environmental Health Sciences
College of Medicine
The Ohio State University