Clinical profile of Central Nervous System Tuberculosis in Kanniya kumari medical college

Bhamini Prakash 1 , Christopher Nesamony 2 , Suhas Raj Sivakumar 3 , Thirukumareswaran Vijayan 3 and Sindhu Neelakandan 3 . 1. Assisstant Professor of Medicine, Kanniyakumari Govt. Medical College. 2. Professor of Medicine, Kanniyakumari Govt. Medical College. 3. Postgraduate in General Medicine, Kanniyakumari Govt. Medical College. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Both as a cause of death and disability, Tuberculosis of the Central Nervous System is of great clinical importance. In children the condition most often arises as a consequence of primary or miliary tuberculosis, but in adults it usually develops in individuals with known tuberculosis elsewhere, especially in the lung. Once a disease mainly of childhood, it is now seen at any age and is equally frequent in adults. The pattern of Tuberculous infection of the Nervous System is changing. In an American epidemiological study of extrapulmonary tuberculosis, up to 10% of cases showed CNS involvement 1 , whereas CDC data showed that 6.3% of extrapulmonary cases (1.3% of total tuberculosis cases) had CNS TB 2 . A study done at Taiwan, 1.5% of TB deaths between 1997 and 2001 were attributable to CNS disease, a percentage that had increased from previous years 3 .

ISSN: 2320-5407
Int. J. Adv. Res. 5(3), 2389-2395 2390 Risk factors for CNS tuberculosis include age (children> adults) HIV-coinfection, malnutrition, recent measles in children, alcoholism, malignancies, the use of immunosuppressive agents in adults and disease prevalence in the community 4 . The clinical presentation is determined by the nature of the pathological process. It commonly takes the form of a meningitis, but encephalopathy (encephalitis) can also occur . At other times, extra medullary Tuberculosis can produce secondary neurological lesions or tuberculosis disease is confined to spinal cord. Seizures, either focal or generalised, may occur during acute illness or months after treatment 5 . In the present study, the vulnerable age group of CNS TB belonged to 15-19 years carrying 23% of the total patients.  In the present study,64% were males and 36% were females.

-Symptom Analysis
In patients with tuberculous Meningitis, fever associated with headache, vomiting was the main presentation, presented in 89.4%. Photophobia was present in 4 cases who also had features of rise in intracranial tension. Numbness in the right half of the body was presented in one case. Weakness of right upper and lower limbs was presented in one case of Tuberculoma of brain.
2 patients of TB Meningitis in the course of their treatment developed spinal arachnoidits in the form of lower limb weakness and numbness after 45 days.
2 patients had potts paraplegia. They presented as weakness and numbness of lower limbs and bladder retention developed in one case in the later period In the present study, higher number of cases had duration of fever for 2-3 weeks . 2 Cases (6.6%) had duration of fever for a longer period, more than 60 days. In the present study generalized seizures were present in 4 patients( 13.3%) , Focal seizures were present in 5 patients (16.6%). Generalised seizures were present invariably in Tuberculous meningo encephalitis patients and focal seizures were present in patients with tuberculoma of brain.  (2) In the present study 7 patients of tuberculous meningitis recovered after treatment without any sequlae. 4 patients developed meningo encephalitis with fits and altered sensorium, and 1patient died during the illness. 1 patient  One case presented with Quadriparesis and dysphagia, died during the illness probably due to brain stem lesion.

Tuberculoma Of The Brain:-
In the present study, 7 cases (23.3%) were found to have tuberculoma of brain. The Incidence of tuberculomas among intracranial space occupying lesions varies from 3.3 -17.6% in different series since 1970.
2395 Papilledema:-Presented in 4 patients with tuberculoma (57.1%). Reported incidence by Tandon study 7 is 87% Tuberculous Arachnoiditis:-In the present study 2 cases of tuberculous meningitis (6.6%), in the course of their treatment later presented as spinal arachnoiditis. They showed good recovery, but they carried a morbidity of paraparesis as their sequlae, but they are on follow up further.

Potts Paraplegia:-
In the present study 2 cases had presented with potts paraplegia(6.6%) Both of them were males, below 40 years and both of them, the thoracic spine was involved. The incidence of potts paraplegia is around 10% of CNS tuberculosis 11 Conclusion:-