Abstract
Central nervous system tuberculosis (CNS-TB) manifests as tuberculous meningitis,
intracranial tuberculoma, or spinal tuberculous arachnoiditis. Children are disproportionately
affected, with high rates of mortality and morbidity reported even in the era of treatment.
Most guidelines for the treatment of drug-susceptible CNS-TB recommend 9 to 12 months
of a standard regimen of isoniazid, rifampin, pyrazinamide, and ethambutol, with the
adjunctive use of corticosteroids early in therapy. Recent trials have demonstrated
improved outcomes with intensified regimens using nonstandard regimens or higher dosages
of standard drugs. Accumulating evidence also supports shorter duration of treatment.
Further investigation is warranted to identify the optimal regimen and duration of
treatment for CNS-TB. Complications such as hydrocephalus may be managed medically
or surgically. Although outcomes have improved with effective chemotherapy and immunomodulation
of disease, prompt diagnosis and treatment in the early stages of disease remain paramount
to improve prognosis.
Keywords
tuberculous meningitis - tuberculoma - intensified regimen - hydrocephalus
