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Tuberculosis

Symptoms of Tuberculosis

10/01/2009

Question:

In 2005 I was treated for TB. In october last year I have fits, and again in December my doctor asked me to do lumbar punch. They told me that my manengies are fine and limphosites are high, so they gave me flucanazoleas a prophylaxis. Last week I have another fit five times. My doctor booked me for CT scan, and told me that I have four rings in my brain. When asked for an explanaition they were not sure what is with me. It is between tuberculomas and neucrocyticers (i am not sure if i am spelling the word right). Can you please tell me what is going on to me?

Answer:

It is very difficult to know what is going on based just on the information you have provided above. It seems like the brain lesions (rings) may be causing you to have fits (seizures). The doctors can give you a medication for the seizures and medication to help decrease the swelling in the brain around the lesions if there is any.

Several infections can cause ring like lesions in the brain. The only way to find out what the lesions are from is by doing a brain biopsy. But depending on where these lesions are located and what they are due to, biopsy may not always be the best step. Sometimes, the doctors can make a preliminary diagnosis based on what the lesions look like on the CT or MRI scan and where the lesions are located. Sometimes you may have clues elsewhere in the body that can help to make a diagnosis like skin lesions, blood tests, or lumbar puncture results. The doctor may give you a trial of medication to treat and see if it gets better.

Tuberculosis can cause brain lesions and most of the time responds very well to medical treatment. I am not sure if your prior TB in October 2005 was TB of the lung or TB meningitis? Did they do drug susceptibility testing to make sure that the TB medications you were taking worked for you? TB can spread to any place in the body, so a tuberculoma can be a possibility in someone with a history of TB. Neurocysticercosis is a very common parasitic infection in certain parts of the world. It is caused by eating tapeworm eggs.

We are not sure if you have any other medical illness besides a history of TB. Some people with weak immune system due to infectious diseases such as human immunodeficiency virus (HIV), cancer, or those that are taking certain medications can develop lesions in the brain from infections due to a weakened immune system. Brain lesions are very difficult to diagnose and may require long term treatment and follow-up. We would advise that you see a specialist for the diagnosis, treatment, and follow-up.

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Response by:

Shu-Hua   Wang, MD, MPH&TM Shu-Hua Wang, MD, MPH&TM
Clinical Assistant Professor of Infectious Diseases
Clinical Assistant Professor of The Division of Epidemiology
College of Medicine
The Ohio State University