Tuberculous brain abscess. Report of a case and review of the literature.

Tuberculous brain abscess is a rarely reported form of central nervous system tuberculosis. Fifty-seven cases were found in a review of the world's literature; only 16 met rigid diagnostic criteria. Tuberculous brain abscesses are devoid of the granulomatous reaction associated with tuberculosis. Histologically and clinically, these abscesses are similar to pyogenic brain abscesses. An analysis of 16 verified cases from the literature and one reported case showed that tuberculous brain abscesses usually present acutely, often in the third and fourth decades, commonly have a supratentorial location, frequently present with focal neurologic signs, and are associated with historical and laboratory evidence of tuberculosis. Tuberculous brain abscesses may be difficult to differentiate from pyogenic brain abscesses, tuberculomas, and tuberculous meningitis on the basis of clinical, laboratory, and roentgenographic information. Appropriate therapy includes adequate antituberculous chemotherapy and surgical excision.