33 years old woman with recurrent episodes of seizure and increased ICP: case of CNS Tuberculosis

Introduction:Central nervous system (CNS) involvement, one of the most overwhelming clinical manifestations of tuberculosis (TB) is noted in to 10% of extrapulmonary TB cases, and accounts for about 1% of all TB cases(1). Clinical spectrum of CNS TB includes meningitis, meningoencephalitis, tuberculoma, tubercular abscess, and stroke due to the vasculitis and cerebral venous sinus thrombosis (CVST)(2).Case report:We report the case of 33 years old woman whose problems had been initialized since years ago so that she was periodically suffering from symptoms of raised ICP such as headache, nausea, vomiting and recurrent seizure but there was asymptomatic periods with 1-2 months intervals between them. Moreover she had one episode of cerebral venous thrombosis months after symptoms onset. Her cranial nerve and sensory motor examination, finger to nose test and gait were normal. She had neither fever nor nervous focal signs and symptoms (no paresis, gaze or facial asymmetry) or symptoms of meningeal irritation. There was no space-occupying lesion in CT scan. In laboratory studies in terms of routine lab tests, coagulation status, viral markers and VDRL, rheumatologic factors, ACE, ADA, serum protein electrophoresis no pathologic findings were observed. LP results mainly included increased OP and increased CSF protein. Bacterial/fungal meningitis panel had no pathologic finding. QuantiFeron test was positive. Regarding to clinical symptoms CNS TB is the most probable diagnosis.Conclusion:The typical analyses of CSF of patients with CNS tuberculosis show moderate lymphocytic pleocytosis, moderately elevated protein levels, and hypoglycorrachia (low glucose). By itself, the CSF profile of CNS tuberculosis mimics the profiles of large list of both infectious and noninfectious diseases that involve the CNS(3). Identification of AFB (acid fast bacilli) in the CSF through both smear and culture methods remains the most important and most widely available means to diagnose CNS tuberculosis. Against its importance among the diagnostic methods used for CNS tuberculosis, classic staining and culture remain somewhat insensitive, most likely due to the typical paucity of AFB in clinical case of CNS tuberculosis(3). QFT is highly specific and sensitive test and positive result is strongly predictive of true infection with M. tuberculosis. However, like the TST and other IGRAs, QFT cannot distinguish between the active tuberculosis disease and latent tuberculosis infection, and is intended for use with risk assessment, radiography, and other medical and diagnostic evaluations.

کلیدواژه ها:

seizure ، CNS TB ، IIH