Pathology of Tuberculosis of the Nervous System (Tuberculous Meningitis, Tuberculoma, Tuberculous Abscess)

Tuberculosis (TB) of the central nervous system (CNS) is a life-threatening manifestation of extrapulmonary TB. It is commonly a consequence of hematogenous dissemination of bacilli following a pulmonary infection. With the emergence of HIV, it is being increasingly acknowledged as a cause of neurological morbidity and mortality in the developed world as well. Neuro-TB may present as meningitis, tuberculoma, or tuberculous abscess. Thick gelatinous basal exudates are the pathological hallmark of the disease in tuberculous meningitis and lead to numerous complications. This chapter details the gross anatomic and microscopic alterations seen in these presentations of TB of CNS. Various differential diagnoses of these lesions are discussed, and an outline of diagnostic modalities available to the treating physician is provided.