Multi-spectral Pattern of Clinical Presentation and the Resultant Outcome in Central Nervous System Tuberculosis: A Single Center Study on the Ubiquitous Pathogen

  • Sunil MunakomiEmail author
  • Giovanni Grasso
  • Rojeena Chapagain
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1271)


Central nervous system (CNS) tuberculosis (TB) is a great medical masquerader having a multi-spectral pattern of clinical presentation, thereby complicating early diagnosis and appropriate management. This review article describes clinical presentation of CNS TB in a group of 47 patients, who were managed in the Nobel Medical College and Teaching Hospital in Biratnagar, Nepal during the last 2 years. We evaluated demographic profile, mode of management, and clinical outcome in these patients. The findings were that intracranial TB was present in 27 (57.5%) patients and the spinal involvement was in 20 (42.5%) patients. The most frequent presentation of the former was TB meningitis with hydrocephalus (55.5%) and that of the latter was Pott’s spine with abscess in 50% of cases. TB meningitis with hydrocephalus was the commonest cause of mortality (83.3%) among the patients. CNS TB should be considered in the differential diagnosis in patients presenting with equivocal neurological signs and symptoms, especially in TB endemic regions. It seems prudent to commence early antitubercular therapy for safeguarding such patients from poor neurological outcome as well as mortality it harbingers.


Central nervous system Clinical outcome Differential diagnosis Meningitis Pott’s spine Tuberculosis 


Conflicts of Interest

The authors declare no conflicts of interest in relation to this article.

Ethical Approval

All procedures and studies described in this review were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The article gained approval from the Institutional Review Committee of the Nobel Medical College and Teaching Hospital (IRC-279/2019).

Informed Consent

As there was no current involvement of any human studies in this review article, consent from individual participants was not required.


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Copyright information

©  Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Sunil Munakomi
    • 1
    Email author
  • Giovanni Grasso
    • 2
  • Rojeena Chapagain
    • 1
  1. 1.Department of NeurosurgeryNobel Medical College and Teaching HospitalBiratnagarNepal
  2. 2.Neurosurgical Clinic, Department of Biomedicine, Neurosciences and Advanced DiagnosticsUniversity of PalermoPalermoItaly

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