Background: tuberculosis meningoencephalitis (TBME) is an acute infectious disease of the central nervous system. The disease had a high mortality rate and severe sequelae if late diagnosis and not timely treatment. However, in recent years, the patients with TBME who was transferred to National Pediatric Hospital Hospital remained to be diagnosed not exactly, affect to treatment outcomes. Objectives: study on the difficulties in diagnosing TBME in children. Subjectives and Method: a descriptive study on 34 children aged 4-14 months diagnosed with TBME at Department of infectious, National Pediatric Hospital from January 2002 to September 2005. Results: 35.29% of the patients were under 1 year old. The suggestive signs and symptoms for diagnosis included BCG\ufffd?scar (50%), tuberculosis exposure (32.4%), weight loss (31.8), fever (100%), vomiting (70.6%), stiff-neck (94.1%), meningeal sign (70.6%), Kernig\u2019s sign (61.8%), positive Tuberculin tests (35.29%) and typical lesions on chest x-rays (11.8%). In cerebrospinal fluids (CSF), mean cell count was 274/mm3 and protein concentration was 1.51g/l. These were hindrances for diagnosing TBME in children. Disease distribution was in both the urban and the rural areas. Conclusions: Clinical manifestations and disease progress are not typical for TBME diagnosis. Therefore, it is important to think about TBME in cases with acute meaningitidis lasting for more than 14 days. PCR will be a very good marker for definite diagnosis.
Meningoencephalitis/ diagnosis ; Tuberculosis ; Meningeal/ diagnosis ; Child ;

CT is a valuable method in determining number, location and extent of lesions, although a definite diagnosisis often not possible on CT. In intracranial tuberculosis, CT was helpful in the diagnosis, assessing the degreeof hydrocephalus and evaluating the effectiveness of antituberculous therapy. Twenty-one cases of clinical lyproven intracranial tuberculosis were studied by CT in our hospital during last 3 years. Of them, eighteen caseswere tuberculous meningitis and the rests were tuberculoma. The results were as follows; 1. Tuberculous meningitis presented the following three patterns of CT findings according to its disease process. a. In early stage of the disease, suspcious multiple isodense small nodules in the cerebral and cerebellar hemispheres showed dense enhancement in postcontrast scan representing miliary tubercles. b. In later stage of the disease, precontrastscan showed partial or total obliteration of the basal and sylvian cisterns with mild dilatation of ventricularsystem. Postcontrast scan showed dense enhancement of basal and sylvian sisterns. This type of finding was themost common in our series. c. Moderate to marked dilatation of ventricle with or without a cluster ofcalcifications in suprsella area on precontrast scan was seen in far later stage or as a sequellae of the disease. No enhancement was noted in postcontrast study. 2. Tuberculoma showed an isodense or slightly hyperdense area inthe cerebral or cerebellar hemisphere with associated minimal edema in precontrast study. Postcontrast scan showeda small ring enhancement with central lucent area.
Diagnosis ; Dilatation ; Edema ; Hydrocephalus ; Methods ; Tuberculoma ; Tuberculosis ; Tuberculosis, Meningeal

We tried to correlate brain CT findings with clinical state at admission and outcome at discharge in 42 selected cases from 94 adult patients under the diagnosis of tuberculous meningitis at Seoul National University Hospital during last four years from 1981. Their clinical state at admission and outcome at discharge were classified into three groups by severity of symptoms, respectively. The final outcome of them were well correlated with their clinical states at admission. Observed abnormal brain CT findings in this series were hydrocephalus (74%), dirthy cisternal enhancement (52%), infraction (38%), periventricular low density (36%), and tuberculoma (19%). The poorer the clinical state at admission and outcome at discharge, the more frequent the abnormal brain CT findings, especially of periventricular low density and infraction. But periventricular low density without infarction seemed to affect more deleterious effect on clinical state at admission than on final outcome.
Adult ; Brain* ; Diagnosis ; Humans ; Hydrocephalus ; Infarction ; Seoul ; Tuberculoma ; Tuberculosis, Meningeal*

Tuberculous brain abscess, an unusual complication of tuberculosis, has been rarely reported worldwide.It should be differentiated from tuberculomas of the brain and pyogenic brain abscess, but on the basis of clinical, laboratory, and roentgenographic information the differential diagnosis is difficult and only pathological plus bacteriological evidence can suffice it. We report a case of tuberculous brain abscess developed during antituberculous therapy in 20-year-old girl who had been suffered from pulmonary tuberculosis and tuberculous meningitis.
Brain Abscess* ; Brain* ; Diagnosis, Differential ; Female ; Humans ; Tuberculoma ; Tuberculosis ; Tuberculosis, Meningeal ; Tuberculosis, Pulmonary ; Young Adult

No abstract available.
Cerebrospinal Fluid* ; Diagnosis* ; Enzyme-Linked Immunosorbent Assay* ; Mycobacterium tuberculosis* ; Mycobacterium* ; Tuberculosis, Meningeal*

BACKGROUND: Rapid and accurate detection of Mycobacterium tuberculosis is important for patients with tuberculous meningitis because early diagnosis and prompt initiation of treatment improve the outcome of the disease. PCR techniques have been applied but are not yet well established for the diagnosis of tuberculous meningitis. The Amplicor(TM) M. tuberculosis test (Roche Diagnostic Systems, Inc. ) can be used fur the detection of M. tuberculosis by PCR technique, but its use has not been recommended currently for extrapulmonary samples. We evaluated the Amplicor(TM) M. tuberculosis test for the direct detection of M. tuberculosis from cerebrospinal fluid (CSF) specimens of patients suspicious of having tuberculous meningitis. METHODS: We examined a total of 103 CSF samples from 76 patients. Tuberculous meningitis was diagnosed by clinical history, chest X-ray, CSF chemistry, bacteriology, computed tomography and response to antituberculous treatment. Twenty-six samples were obtained from 13 patients with tuberculous meningitis. For the Amplicor(TM) M. tuberculosis test, 0.3 - 2.0 mL of CSF was centrifuged at 15,000 rpm for 15 min and its pellet was treated as the instructions of the kit. RESULTS: Of the 103 CSF samples, none were smear-positive by Ziehl-Neelsen acid-fast stain, seven were culture-positive and twelve were PCR-positive. Of the 26 samples from 13 patients with tuberculous meningitis, seven from six patients were culture-positive and eleven from six patients were PCR-positive. The sensitivity, specificity, positive and negative predictive values of the Amplicor(TM) M. tuberculosis test for the patients compared to the clinical diagnosis were 46.2, 98.4, 85.7, and 89.9%, respectively, while the culture yielded 46.2, 100.0, 100.0, and 90.0%, respectively. CONCLUSIONS: The Amplicor(TM) M. tuberculosis test using CSF specimen for the diagnosis of tuberculous meningitis is specific and is as sensitive as culture. The assay will provide rapid and valuable information for the diagnosis and control of tuberculous meningitis.
Bacteriology ; Cerebrospinal Fluid ; Chemistry ; Diagnosis* ; Early Diagnosis ; Humans ; Mycobacterium tuberculosis ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Thorax ; Tuberculosis* ; Tuberculosis, Meningeal*

BACKGROUND: Rapid and accurate detection of Mycobacterium tuberculosis is important for patients with tuberculous meningitis because early diagnosis and prompt initiation of treatment improve the outcome of the disease. PCR techniques have been applied but are not yet well established for the diagnosis of tuberculous meningitis. The Amplicor(TM) M. tuberculosis test (Roche Diagnostic Systems, Inc. ) can be used fur the detection of M. tuberculosis by PCR technique, but its use has not been recommended currently for extrapulmonary samples. We evaluated the Amplicor(TM) M. tuberculosis test for the direct detection of M. tuberculosis from cerebrospinal fluid (CSF) specimens of patients suspicious of having tuberculous meningitis. METHODS: We examined a total of 103 CSF samples from 76 patients. Tuberculous meningitis was diagnosed by clinical history, chest X-ray, CSF chemistry, bacteriology, computed tomography and response to antituberculous treatment. Twenty-six samples were obtained from 13 patients with tuberculous meningitis. For the Amplicor(TM) M. tuberculosis test, 0.3 - 2.0 mL of CSF was centrifuged at 15,000 rpm for 15 min and its pellet was treated as the instructions of the kit. RESULTS: Of the 103 CSF samples, none were smear-positive by Ziehl-Neelsen acid-fast stain, seven were culture-positive and twelve were PCR-positive. Of the 26 samples from 13 patients with tuberculous meningitis, seven from six patients were culture-positive and eleven from six patients were PCR-positive. The sensitivity, specificity, positive and negative predictive values of the Amplicor(TM) M. tuberculosis test for the patients compared to the clinical diagnosis were 46.2, 98.4, 85.7, and 89.9%, respectively, while the culture yielded 46.2, 100.0, 100.0, and 90.0%, respectively. CONCLUSIONS: The Amplicor(TM) M. tuberculosis test using CSF specimen for the diagnosis of tuberculous meningitis is specific and is as sensitive as culture. The assay will provide rapid and valuable information for the diagnosis and control of tuberculous meningitis.
Bacteriology ; Cerebrospinal Fluid ; Chemistry ; Diagnosis* ; Early Diagnosis ; Humans ; Mycobacterium tuberculosis ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Thorax ; Tuberculosis* ; Tuberculosis, Meningeal*

A 24-year-old man with tuberculosis meningitis developed acute paraplegia and sensory disturbances 5 weeks after receiving conventional antituberculous therapy. Magnetic resonance imaging revealed an intradural extramedullary long segmental mass mimicking en plaque meningioma at the T2-T6 vertebrae levels. Prompt surgical decompression was performed. A histology examination of the mass revealed a tuberculoma. After surgery, the patient showed improved motor power and a normal bladder function. Intradural extramedullary tuberculoma of the spinal cord is rare complication of tuberculosis meningitis, which can occur as a response to conventional antituberculous therapy.
Diagnosis, Differential ; Humans ; Male ; Meningeal Neoplasms/*diagnosis ; Meningioma/*diagnosis ; Spinal Cord Diseases/*diagnosis/surgery ; Thoracic Vertebrae ; Tuberculoma/*diagnosis/surgery ; Tuberculosis, Meningeal/*diagnosis/surgery ; Young Adult

The clinical picture and CSF findings in cryptococcal meningitis may be identical with those of tuberculous meningitis. The differential diagnosis can be made by finding the budding yeast organism in the counting chamber of in stained smear, the detection of cryptococcal antigen in CSF by the latex agglutination test, and by culture of the fungus on Sabouraud agar. We experienced a case of cryptococcal meningitis in the 48 years old woman, which was confirmed by Indian ink preparation and culture.
Agar ; Diagnosis, Differential ; Female ; Fungi ; Humans ; Ink ; Latex Fixation Tests ; Meningitis, Cryptococcal* ; Saccharomycetales ; Tuberculosis, Meningeal

By means of a sensitive radioirnrnunoassay method,ferritin was assessed in the cerebrospinal fluid (CSF) of 50 hospitalized subjects to evaluate its potential value for the diagnosis of tuberculous rneningititis. The rnean ferritin value obtained in the controls was 4.29ng /rnl with ranging between 1.7 and7.4ng/rmL The differences of CSF ferritin content between controls and patients with aseptic rneningitis as well as other non-infectious neurologic disorder were not significant. But rnarked elevation ranging 14 and 88ng/rnl (rnean, 37.4ng/rnl) were observed in patients with tuberculous rneningitis. And the ratio of CSF ferritin to serum ferritin in paients with tuberculous rneningitis was elevated significantly rnore than those in other groups inculuding controls, patients with aseptic rneningitis and other non-infectious neurologic disorder. The level in the serurn and CSF were independent, but that in CSF correlated vrith its total protein content. Results of this study suggest rneasuring CSF ferritin level are a valuable adjunct in differentiating aseptic meningitis from uncomplicated tuberculous meningitis.
Cerebrospinal Fluid ; Diagnosis ; Ferritins* ; Humans ; Meningitis* ; Meningitis, Aseptic ; Nervous System Diseases ; Tuberculosis, Meningeal