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Tuberculosis

Brain TB Treatment after Haemmoraigh

06/09/2010

Question:

My brother (age 27 years, mechanical engineer) had a brain haemmoraigh (left pereito-temporol vascular insult) with partial left transverse sinus thrombosis before 2 and half months, and after treatment he is perfectly fine and all his body parts, brain memory are perfect (CTA and MRI done and it is clear now). Doctors till now could not find the reason behind the attack. They have started the medicine of Brain TB on suspicion but there is no diagnisis as all the test CBF is TB negative. My brother has no medical history, no high blood pressure, no sugar nothing. Only thing is he took H1N1 vaccination 2 month before this attack. Please guide me what could be the reason so that we take precaution and the attack does not repeat. Medicie now being given INH 300mg, Prednisolone 15 mg, Pyridoxine, Moxifloxacine, clarithromycine, amikacine.

Answer:

Without knowing all of the information, it is very difficult for us to comment about your brother’s condition. We are happy that he has made a full recovery.

We will try to provide you with general comments regarding TB of the brain or Central Nervous System (CNS). Brain hemorrhage is rare but can be a complication of CNS TB. In areas of the world where there is a lot of TB, one has to consider TB as a cause for CNS hemorrhage. I am not sure if your brother had any history of exposure to someone with TB disease either as a child or later. Also, did your brother have a positive tuberculin skin test or interferon gamma release blood assay? These test help to screen someone for a history of TB infection. But even if these tests are negative, your brother may still have CNS TB.

TB of the brain is a very serious medical condition and it can be very difficult to diagnose. Often times, it may not be possible to get any positive laboratory result (smear or culture) from the cerebral spinal fluid (CSF). Sometimes the cell count of the CSF fluid may be suggestive of infections such as TB. Sometimes a PCR test can be done on the fluid to help make the diagnosis, but this test is not always available.

Most of the time, the doctors will consider the history, the clinical presentation, the test results that they do have, and the other work-ups that are negative, and make the diagnosis of clinical TB. Patients are usually started on treatment for TB disease because the risk of not treating TB can be very serious. Close follow-up with a TB specialist and neurologist is recommended.

Patients with CNS TB are usually given a steroid (prednisolone) for a short period of time. The other medications that your brother is currently on Isoniazid (INH), moxifloxacin, clarithromycin, and amikacin are not the usual first line combination of TB medications given unless drug resistance is suspected. Since we do not know the common drug resistance patterns of the TB strain in your area, it is difficult for us to comment about the medication. We would recommend that you consult with your physician and specialist regarding your brother’s condition and the medications that they have prescribed for him.

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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