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INN) 2018;24(5, NEURO INFECTIOUS DISEASE):1422–1438.  \nAddress correspondence to Dr Joseph R. Zunt, Harborview Medical Center, 325 Ninth Ave, Box 359775, Seattle, WA 98104, [jzunt@uw.edu](jzunt@uw.edu).  \nRELATIONSHIP DISCLOSURE: Dr Zunt receives research/grant support from the National Institutes of Health (2D43 TW009345-06, 1D43TW009137-01A1,  \n1D43TW009375-01A1, 1D43TW009763-01) .  \nUNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE:  \nDr Zunt reports no disclosure.  \n© 2018 American Academy of Neurology.  \nTuberculosis of the  \nCentral Nervous System  \nBy Joseph R. Zunt, MD, MPH  \nABSTRACT  \nPURPOSE OF REVIEW: This article details the epidemiology and clinical manifestations of central nervous system (CNS) tuberculosis (TB), provides guidance for diagnostic imaging and CSF testing, and recommends treatment strategies for tuberculous meningitis and other forms of CNS TB, illustrating key aspects of diagnosis and management with case presentations.  \nRECENT FINDINGS: Although improvements in our understanding of the pathogenesis and management of CNS TB have occurred over the past 50 years, the emergence of multidrug-resistant and extensively drug-resistant TB, the advent of acquired immunodeficiency syndrome (AIDS), and the subsequent availability of highly active antiretroviral therapy that can produce the immune reconstitution inflammatory syndrome have complicated the diagnosis and treatment of CNS TB.  \nAdvances in diagnostic assays promise to increase the speed of diagnosis as well as the percentage of people with a confirmed rather than a presumptive diagnosis. Advances in precision medicine have identified polymorphisms in the LTA4H gene that influence the risk for inflammation in patients with tuberculous meningitis.  \nSUMMARY: CNS TB continues to be a major cause of morbidity and mortality, with the majority of people affected living in low-income and middleincome countries. Newer diagnostic assays promise to increase the speed of diagnosis and improve appropriate selection of antituberculous therapy and anti-inflammatory medications. Despite these advances, CNS TB remains difficult to diagnose, and clinicians should have a low threshold for initiating empiric therapy in patients with presumptive infection.  \nINTRODUCTION  \nA  \nccording to the World Health Organization (WHO), seven countries account for 64% of the world’s tuberculosis (TB) infections: India, China, Indonesia, Philippines, Pakistan, Nigeria, and South Africa; this distribution of TB closely mirrors the distribution of poverty, malnutrition, and low income.1 Risk factors  \nfor acquiring pulmonary TB include malnutrition, human immunodeficiency virus (HIV) infection, injection drug use, diabetes mellitus, chronic use of corticosteroids, chronic renal failure/hemodialysis, silicosis, solid organ transplantation, and carcinoma ofthe head or neck.2  \n1422 OCTOBER 2018  \nRisk factors for developing central nervous system (CNS) TB include malnutrition, alcoholism, concomitant malignancy, use of immunosuppressive medications, HIV infection, recent measles, and measles in childhood.3–8 Studies in developed countries have also identified that individuals born outside of developed countries are overrepresented among CNS TB cases.9 Although CNS TB occurs most often as a complication of pulmonary TB, imaging of the lungs may reveal what appears to be quiescent infection; it is not uncommon to have CNS TB manifest in individuals who were treated for pulmonary TB years or even decades previously.  \nHUMAN IMMUNODEFICIENCY VIRUS COINFECTION  \nMore than 50% of people with HIV/TB coinfection develop extrapulmonary TB, and individuals who are HIV positive are up to 5 times more likely to develop CNS involvement during TB infection than individuals who are  \nHIV negative.10,11 In addition, paradoxical development of intracranial tuberculomas has been reported in pat","cbCaiqhaYrZyASSE","https://ap.wps.com/l/cbCaiqhaYrZyASSE","pdf",1268543,17,"English","# Introduction\n## Epidemiology and risk factors\n# HIV Coinfection\n## Impact on CNS involvement and testing\n# Tuberculous Meningitis\n## Clinical features and proposed dissemination mechanisms","[{\"question\":\"What does the review focus on regarding central nervous system tuberculosis?\",\"answer\":\"It covers epidemiology and clinical manifestations, guidance for diagnostic imaging and CSF testing, and treatment strategies for tuberculous meningitis and other CNS TB forms.\"},{\"question\":\"How do multidrug-resistant TB and AIDS affect diagnosis and treatment of CNS TB?\",\"answer\":\"They complicate diagnosis and management through resistant disease dynamics and HIV-related immune changes, including immune reconstitution inflammatory syndrome after antiretroviral therapy.\"},{\"question\":\"Why is tuberculous meningitis considered the most common CNS TB manifestation?\",\"answer\":\"It occurs most often in young children, frequently within about three months of primary infection, and presents with symptoms such as fever, vomiting, and apathy.\"}]","Tuberculosis of the Central Nervous System - Review Article | PDF",1790549693,43]