Evaluation of Twelve Patients with Tuberculous Meningitis

Objective: To assess the presentation, diagnosis and treatment of patients with tuberculous meningitis (TM). Material and Methods: Clinical and laboratory findings of 12 patients with TM, followed-up between 2000 and 2004, were evaluated retrospectively. Results: Seven male and five female patients were enrolled in this study. The mean age of the patients was 34.5 years. Culture of cerebrospinal fluid (CSF) in 10 cases revealed Mycobacterium tuberculosis. None of the CSF samples was positive for acid-fast bacteria (AFB) by Ehrlich-Ziehl-Neelsen (EZN) staining. M. tuberculosis was also isolated from the sputum sample of one patient. Isoniasid (INH) resistance was detected in two isolates. The most frequent finding on cranial computerized tomography (CT) and magnetic resonance imaging (MRI) was tuberculoma. Hydrocephalus was observed in 4 cases. Five patients had pulmonary lesions on chest radiographs. One patient had cavitation on the right upper zone, one patient had bilateral apical hyperdensity, and three patients had miliary involvement. Liver toxicity due to anti-tuberculosis drugs developed in 2 patients. Paradoxical enlargement of tuberculomas was detected during therapy in one case. Cranial MRI appeared to be more sensitive than CT in detecting intracranial lesions of four patients. Three patients died and neurological sequels developed in three patients. Conclusion: Early diagnosis and treatment is of major importance in TM, which is the most serious form of extrapulmonary tuberculosis. However, some problems such as drug toxicity and resistance, and occurrence of paradoxical response during follow up cause problems in treatment course.