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1996-03-04
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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).