[Central nervous system tuberculosis: diagnosis and therapy].

Tuberculous meningitis is the most serious form of tuberculosis, but often the only manifestation of tuberculosis with non-specific initial signs and symptoms. Therefore, delayed diagnosis occasionally results into rapid progression of neurologic deficits and a poor prognosis. So, it is needless to mention that appropriate chemotherapy should be started as fast as possible under swift diagnosis. According to recent progression of molecular biological technique, PCR and other nucleic acid amplification methods are becoming to be quite useful for rapid detection of Mycobacterium tuberculosis in the cerebrospinal fluid. If diagnostic tests are not definitely positive but there is a strong clinical suspicion for tuberculous meningitis, it is advisable to start the antituberculous chemotherapy as soon as possible. The combination chemotherapy with isoniazid, rifampicin, pyrazinamide, and streptomycin (or ethambutol) is a standard treatment for tuberculous meningitis. The administration of corticosteroids with adequate antituberculous chemotherapy should be considered in severe cases for reduction in mortality and neurologic sequelae, especially when there is the indication of subarachnoid block or impending brain herniation.