Central Nervous System Tuberculosis: Clinical Characteristics and Outcome. A Saudi Tertiary Care Centre Experience

Background: Tuberculosis is an endemic problem that is of important public health concern in Saudi Arabia. Available recent prevalence of tuberculosis (pulmonary and extra-pulmonary) was estimated to be 13.7 per 100,000 people living in the Kingdom of Saudi Arabia. Methods: A retrospective chart review of all Central Nervous System tuberculosis patients (CNS-TB) treated at King Abdulaziz Medical City, Riyadh, Saudi Arabia between 1996 and 2010. CNS-TB was defined as follows: patients who had symptoms and signs of CNS-TB with radiographic, microbiologic, or histopathologic evidence of tuberculous infection and/or those with highly probable diagnosis, supported by radiographic typical features, not confirmed microbiologically but who responded to anti-TB therapy. Results: Eighty two patients (46 males) met our definition with the mean age of 50 years. Only 11 patients (13.4%) reported previous TB infection. The most common presenting symptoms were: headache (51%), fever (50%), weakness (43%), confusion (29%) and seizures (28%). The most common signs found by clinical examination were: weakness (45%) followed by sensory impairment. Positive CSF acid-fast bacilli (AFB) culture confirmed the diagnosis in 20 out of 49 tested patients (about 41%). Brain CT scan was done in 74 patients and meningeal enhancement was identified in only 6 patients (8%) but ring enhancing lesions were found in 19 patients (26%). In MRI meningeal enhancement was founded in 26 patients (37%) and ring enhanced lesions in 36 patients (51%). After receiving treatment, 45 patients (55%) had complete or good recovery and 23 patients (28%) had partial recovery. However, 15% (12 patients) had poor or no improvement. 2 patients (2%) lost their follow up. Conclusion: CNS-TB continues to be a major health issue especially in endemic areas such as Saudi Arabia. The diverse clinical presentations, lack of high yield, practical and reliable diagnosis methods and inconsistent management plans require further research and harder work in order to meet the current challenges and reach a unified case definition and evidence based management guidelines that would be a very practical step.