From the Guidelines
Tuberculous encephalopathy is a severe and potentially life-threatening condition characterized by diffuse cerebral edema, neurological symptoms, and increased intracranial pressure, requiring prompt initiation of anti-tuberculosis therapy and adjunctive corticosteroids to reduce morbidity and mortality. The clinical features of tuberculous encephalopathy are similar to those of tuberculous meningitis, with high short-term morbidity and mortality reported regardless of HIV serostatus 1. Key features of tuberculous encephalopathy include:
- Altered mental status
- Seizures
- Focal neurological deficits
- Signs of increased intracranial pressure such as headache, vomiting, and papilledema
- Fever
- Meningeal signs
- Cranial nerve palsies
- Behavioral changes Imaging typically shows diffuse cerebral edema, hydrocephalus, and occasionally tuberculomas. CSF analysis reveals lymphocytic pleocytosis, elevated protein, and low glucose, though acid-fast bacilli are often absent 1. The treatment of tuberculous encephalopathy requires standard anti-tuberculosis therapy, which includes isoniazid, rifampin, pyrazinamide, and ethambutol, for at least 9-12 months, along with corticosteroids like dexamethasone to reduce inflammation and cerebral edema 1. The use of adjunctive corticosteroid therapy with dexamethasone or prednisolone tapered over 6–8 weeks is strongly recommended for patients with tuberculous meningitis, which is similar to tuberculous encephalopathy, due to its mortality benefit. Supportive care includes anticonvulsants for seizures and measures to manage increased intracranial pressure. Early diagnosis and treatment are crucial to prevent permanent neurological damage or death.
From the Research
Features of Tuberculous (TB) Encephalopathy
- TB encephalopathy is a rare presentation of central nervous system tuberculosis, with a highly variable clinical presentation ranging from mild illness to a potentially fatal one 2
- The pathophysiology of TB encephalopathy is believed to have an immune mechanism without any direct invasion by the tubercular bacilli 2
- Characteristic signs of meningitis and cerebrospinal fluid findings are mild or absent in TB encephalopathy 2
- Diffuse white matter edema and demyelination have been noted in TB encephalopathy 2
- TB encephalopathy can present with abnormal behavior, mental impairments, motor type paralysis, and seizures due to brain damage caused by the infection 3
Diagnosis and Treatment
- Diagnosis of TB encephalopathy is challenging due to the absence of characteristic signs of meningitis and cerebrospinal fluid findings 2
- Treatment of TB encephalopathy involves antitubercular therapy, which has been shown to be effective in responding to the condition 2
- The use of adjunctive corticosteroids may be considered in the treatment of TB encephalopathy, although its role is not well established 4, 5
- Early intervention and rapid diagnosis are vital for a successful outcome in patients with TB encephalopathy 3
Epidemiology and Demographics
- TB encephalopathy has been reported mainly in the pediatric population, with only a few case reports in the adult population 2
- Tuberculosis infections of the central nervous system, including TB encephalopathy, are a serious and often fatal disease predominantly impacting young children 3
- As much as one-third of the current world's population may be infected with tuberculosis, making it a significant public health concern 3