       Document 0584
 DOCN  M9640584
 TI    Central nervous system tuberculosis: medical management and surgical
       indications.
 DT    9604
 AU    Gropper MR; Schulder M; Sharan AD; Cho ES; Division of Neurosurgery,
       Northwestern Memorial Hospital,; Chicago, Illinois 60611, USA.
 SO    Surg Neurol. 1995 Oct;44(4):378-84; discussion 384-5. Unique Identifier
       : AIDSLINE MED/96149527
 AB    BACKGROUND: An increase in the incidence of tuberculosis in
       industrialized nations has prompted a need for earlier diagnosis,
       treatment, and isolation of disease. An associated rise in the number of
       patients with central nervous system tuberculosis (CNS TB) has forced
       neurosurgical services to reevaluate the indications for operative
       intervention. METHODS: Seventeen cases of CNS TB were found in a
       retrospective review of all cases managed on the neurosurgical service
       between 1989 and 1994. These cases included eight with tuberculous
       meningitis, seven cases of supratentorial tuberculomas, and two cases of
       infratentorial tuberculomas. RESULTS: Major permanent neurologic
       morbidity was seen in one case (6%). Five patients (29.4%) died of
       complications associated with their primary disease. Eleven patients
       (64.6%) had excellent outcomes. All patients in the latter group
       completed an 18-month course of antituberculous therapy. Cerebrospinal
       fluid shunts were necessary in three cases and emergent craniotomy was
       performed in three cases. Only four cases had human immunodeficiency
       virus (HIV) coinfection. CONCLUSION: The neurosurgeon's role in the
       management of CNS TB has once again become more evident. In the present
       series it is unclear as to whether this is due to multiple
       drug-resistant strains of Mycobacterium tuberculosis or HIV coinfection.
       It is clear, however, that vigilance over patient compliance and serial
       neurologic evaluation will determine the need for operative
       intervention.
 DE    Adult  Child  Drug Resistance, Microbial  Drug Resistance, Multiple
       Dura Mater  Female  Human  Length of Stay  Male  Middle Age  Treatment
       Outcome  *Tuberculoma, Intracranial/DIAGNOSIS/THERAPY  *Tuberculosis,
       Meningeal/DIAGNOSIS/THERAPY  JOURNAL ARTICLE  REVIEW  REVIEW OF REPORTED
       CASES

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

