What is it?

Tuberculosis of meninges and CNS ,is the most dangerous extrapulmonary manifestation of tuberculosis, and carries a high morbidity and mortality rate. It is caused by an infection by Mycobacterium tuberculosis. It includes meningitis, tuberculoma, and spinal arachnoiditis.If left untreated tuberculosis meningitis can lead to seizures, hydrocephalus, deafness, mental retardation, hemiparesis and other complications. Tuberculoma lesions may occur in the brain, spinal cord, subarachnoid, subdural, or epidural space; they may be solitary but are most often multiple and accompanied by surrounding edema . Tuberculous abscesses tend to be larger than tuberculomas, often larger than 3 cm in diameter. Immunosuppression, due to either human immunodeficiency virus infection or solid organ transplantation, increases susceptibility for acquiring or reactivating CNS TB.

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Signs & symptoms

Symptoms and signs of TB meningitis may include headaches, behavioral changes,fever, stiff neck, and vomiting. Then, symptoms may progress to irritability, confusion, drowsiness, stupor and even coma. Tuberculoma symptoms include headache, seizures, focal neurological deficits and papilledema. The clinical presentation of tuberculous abscess is typically more acute than tuberculoma and includes fever, headache, and focal neurologic deficits


High clinical suspicion, combined with cerebrospinal fluid analysis and brain imaging studies, can improve the diagnostic certainty. The Mantoux test is the recommended standard tuberculin skin test. Interferon gamma release assay (IGRAs) tests may be done to evaluate specific antigens. PCR tests may also detect the tuberculosis antigen.


Meningeal tuberculosis treatment is treated like pulmonary TB- with 4 drugs (rifampin, isoniazid, pyrazinamide, and ethambutol) for 9-12 months. Corticosteroids may also be of benefit.

☝️ This is not a substitute for professional medical advice. Please consult with your physician before making any medical decision.

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