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nervous system tuberculosis is the most severe form of extrapulmonary tuberculosis
disease. We aim to review the diagnostic and radiological
features, pathogenesis, and biomarkers of tuberculous meningitis. We also aim
to look at the latest development of research of the disease. The diagnosis of
tuberculous (TB) meningitis is difficult because the disease presents with
unspecific clinical features. However, the disease has excellent
clinical response to antituberculous
therapy. Good prognosis depends on prompt diagnosis with treatment and
radiological findings are very important. There is an increase in the levels of
serum and cerebrospinal fluid (CSF) TNF-in TB meningitis patients. IL-6 level
is also increased in patients with tuberculoma and exudates. There is an
increase in the levels of serum and CSF TNF-α and IFN-γ in TB meningitis patients. There is also a rise in the levels of
IL-8, IFN-alpha, IFN-gamma, IL-10, CSF matrix metalloproteinases, CSF tissue inhibitors of
matrix Metalloproteinases, VEGF level, caspase-1 and IL-1β. Signal-regulatory
protein alpha is overexpressed at mRNA level. High dose intravenous rifampicin
(800 mg daily) is associated
with reduced mortality in patients with advanced disease.
stroke is uncommon. We are presenting an interesting case of a patient with
rare isolated left midbrain stroke. The patient had third cranial nerve palsy.
Magnetic resonance imaging (MRI) brain showed acute stroke at the medial part
of left midbrain. Magnetic resonance angiography (MRA) was normal.