Tuberculosis of the central nervous system.

We report on the clinical features, management, and outcome of 27 patients with tuberculous disease of the central nervous system admitted to the London Hospital over six years. Seventeen presented with meningitis, and in nine of these there was bacteriological confirmation of tuberculous disease although acid fast bacilli were only found in the CSF of four patients. This appeared to carry a poor prognosis. There was a high incidence of rifampicin-induced hepatitis. The outcome was satisfactory in six out of seven patients in whom no AFBs were cultured. Eleven patients presented with intracranial tuberculomas but without evidence of systemic TB. The CT scan revealed mass lesions, but only in three patients was the appearance pathognomonic of tuberculoma. However, biopsy can be a hazardous procedure and led to the death of two of our patients. Where possible, surgical intervention should be avoided, and the response to medical treatment assessed by CT scan.