[Tuberculosis infection in the nervous system].

Most cases of Mycobacterium tuberculosis infection in the nervous system involve tuberculous meningitis (TBM), which is a severe form of extrapulmonary tuberculosis. Patients who demonstrate a subacute clinical course with headache, vomiting, pyrexia and anorexia should be suspected of having TBM. Diagnosis is based on the clinical symptoms, and cerebrospinal fluid changes (increased protein, low glucose and mononuclear cell pleocytosis). Cerebrospinal fluid smear examination, mycobacterial culture and finding on polymerase chain reaction are useful for establishing a definitive diagnosis of TBM. Mortality and sequelae of patients with TBM are high with no or delayed treatment. Therefore, before definitive diagnosis of TBM, empirical anti-tuberculosis therapy should be started in all patients suspected of having TBM. The recent British Infection Society guidelines indicate that treatment for TBM should comprise isoniazid, rifampicin, pyrazinamide and ethambutol for two months followed by isoniazid and rifampicin for at least 10 months. Adjunctive corticosteroid should also be administered.