| Element | Comment |
|---|---|
| At risk | Birth in a region with a high incidence of tuberculosis (TB) (e.g. India, Pakistan and Africa) Recent contact with TB Previous pulmonary TB Alcohol- or substance-use disorder Immunosuppression (organ transplant, lymphoma, steroid therapy, anti-TNF therapy, HIV/AIDS) |
| Suggestive clinical features | Subacute onset Cranial nerve palsies Retinal tubercles (pathognomonic but rarely seen) Evidence of extra-meningeal TB (e.g. miliary change on CXR) Hyponatraemia |
| CSF findings | Raised opening pressure High lymphocyte count High protein level Rare for acid-fast bacilli to be seen on microscopy, but PCR for M. tuberculosis DNA has a higher sensitivity |
| CT brain | Hydrocephalus common Cerebral infarction due to arteritis may be seen Tuberculomas may be seen |
| Treatment | Combination chemotherapy with isoniazid (plus pyridoxine to avoid neuropathy), rifampicin, pyrazinamide and ethambutol Consider adjunctive dexamethasone (seek expert advice) |