1/3. Intracranial and spinal tuberculosis requiring neurosurgical intervention. The Wellington Hospital experience 1998-2001.AIMS: To describe the Wellington Neurosurgical Unit's recent experience of managing tuberculosis between January 1998 and January 2001. methods: patients with microbiologically confirmed tuberculosis of the central nervous system and whose management included surgery are described. Personal recall and review of the hospital records were used to extract relevant data. RESULTS: Five patients were identified. As well as involvement of the brain parenchyma, meninges, spinal cord or spinal column, all had evidence of tuberculosis elsewhere. All but one patient deteriorated neurologically after being started on antituberculous chemotherapy. CONCLUSIONS: The number of patients presenting with neurotuberculosis appears to have increased recently in the Wellington region. The high proportion of paradoxical progression in our series is unusual. Neurosurgical intervention may be required for diagnosis, to treat hydrocephalus, or to relieve mass effect. Management is prolonged and often complex, and close co-operation is required between the neurosurgical team and a physician experienced in the management of tuberculosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. Tuberculous spondylitis as a complication of intravesical bacillus Calmette-Guerin therapy.We report a case of tuberculous spondylitis following intravesical bacillus Calmette-Guerin (BCG) instillation. A 90-year-old male physician living in South africa received an uncomplicated 6-week course of intravesical BCG (Japanese 172 strain) for high grade superficial bladder carcinoma. He experienced a sudden onset of debilitating lower back pain 16 months following this treatment. A lytic lesion involving the anterior T11 and T12 vertebral bodies was diagnosed and subsequently biopsied. An acid-fast organism was isolated after 3 weeks of incubation and was confirmed through deoxyribonucleic acid probe hybridization as a mycobacterium. High performance liquid chromatography analysis speciated the organism as mycobacterium bovis BCG, proving that it was acquired through the intravesical therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/3. Spinal tuberculosis: a report of five cases and a review.Spinal tuberculosis (TB) is an uncommon occurrence in developed countries. We present five cases of spinal TB illustrating some of the problems that can be encountered in clinical practice. Delay in diagnosis due to physicians unawareness of TB as a diagnostic possibility in patients with persistent back pain was observed in two patients. A high clinical index of suspicion is, therefore, needed for diagnosis. tuberculin skin testing was positive in four patients. Computed tomography (CT) has become the examination of choice. It allows precise location of lesions and their extension to paraspinal soft tissue. Furthermore, abscess aspiration and biopsy specimens can be obtained under CT guidance. magnetic resonance imaging in patients with neurological involvement may provide better information than CT. Definitive diagnosis depending on histological examination, smear and culture of biopsy material, however, may be difficult to obtain. In three patients, diagnosis was based on clinical presentation and response to therapy. Antituberculosis chemotherapy was highly effective in curing all patients. Management of patients should be ensured by experts in antituberculosis chemotherapy, usually chest physicians.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |