Tuberculosis of the nervous system: a clinical, radiological and pathological study of 39 consecutive cases in Riyadh, Saudi Arabia

Abstract

Thirty-seven consecutive adults and 2 children with tuberculosis of the nervous system were studied. Twenty-eight patients (72%) had intracranial or intraspinal tuberculomas and only 11 patients (28%) had tuberculous meningitis. Of the 14 patients (36%) with intracranial tuberculomas 6 presented with epilepsy of late onset including convulsive status epilepticus(2). The 6 patients with multiple tuberculomas some of which were situated in the infratentorial compartment were surprisingly free of major neurological disability or systemic disturbance. Thirteen patients (33%) presented with spinal cord compression due to tuberculoma. Eight of these had associated bony abnormalities such as collapsed vertebrae and loss of pedicles usually regarded as characteristic of malignant disease and 2 presented with clinical features of acute transverse myelitis. Eleven patients (28%) had tuberculous meningitis. One of these died, 1 had a protracted illness with gait ataxia and hydrocephalus and 1 other patient was disabled by hemiplegia, dysphasia and epilepsy but the remaining 8 recovered fully. Tuberculosis outside the nervous system was found in 13 patients (33%) in 12 (31%) of whom it was pulmonary. Acid fast bacilli were demonstrated by Ziehl-Neelsen stain in 16 patients (52%) out of 31 from whom specimens were available. Mycobacterium tuberculosis was eventually cultured from only 6 specimens. These data suggest that the clinical and radiological features of tuberculosis of the nervous system in Saudi Arabia may differ substantially from those reported from other countries. In our study there was low morbidity and low fatality rate. Two patients had infratentorial tuberculomas, and 8 patients had bony abnormalities in the vertebral column, typical of malignant disease.