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What causes brain TB?

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Posted on Fri, 7 Apr 2017
Question: Brain TB Improvement after 18 months but increased at the end of 2 years

Hello Doctors,
Good Evening.
My mom has been diagnosed with Lymph node TB and Brain TB. Here is the history
2012 - Diagnosed with TB of lungs. TB treatment for 8 months and was cured.
Feb 2015 - Diagnosed with lymph node TB. TB treatment started (4 TB treatment tablets)
March 2015 - She had a seizure, MRI SCAN showed brain TB. Continued same medicines and 60 injections(streptomycin). MDR TB test was Negative
Nov 2015 - MRI SCAN showed that TB in the brain increased. TB of lymp node reduced. Continued with the same tablets.
July 2016 - MRI Scan showed great improvement, over 70% of TB in the brain reduced. Only 1 TB tablet for the next 6 months XXXXXXX 2017 - She was feeling weak, dizzy, slight headaches etc
March 2017 - MRI SCAN shows significant increase in brain TB as compared to July 2016 scan. Doctor advised to continue 1 TB tablet and also prescribed Descort 30mg for 10 days and advised to come back after 10 days

Here are some of my questions, please advise
(1) Is it common for the brain TB to increase after great improvement while still on TB medication? If so what could be the reasons? Could reducing the 4 tablets to 1 after 18 months be the reason?

(2) She was tested negative for MDR TB (sample from lymp node swelling) in July 2015, what are the chances for it to be MDR TB now?

(3) Her lymph node swelling is complete gone now so how can we test for MDR TB and is it necessary?

(4) What are accurate diagnosis and treatment options now and the best way to proceed?

My mom is currently getting treatment but can do her day to day stuff without any problem but she has weakness, cough dizziness etc from time to time. Please help me with my questions. Thank You so much.
XXXXXXX

doctor
Answered by Dr. Neeraj Kumar (2 hours later)
Brief Answer:
Provide more details as asked

Detailed Answer:
Hello,
I have gone through your question and understand your concern.
Sometimes tuberculosis may paradoxically worsen after treatment due to rising immunity.
The second possibility of MDR TB is ruled out with investigations.
Brain tuberculosis and particularly tuberculoma or abscess may persist for many years requiring prolonged treatment.
Such scenario is seen in about one third of tuberculosis patients.
You can upload images of brain mri for review.
The number of drugs is reduced after initial few months. Provide details regarding medicines too.
If neck lymph node is responding then possibility of MDR TB is less likely.
The diagnosis of TB can be accurately proven if bacteria is detected in sample.
Hope you found the answer helpful.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Neeraj Kumar (2 days later)
Thank You Dr XXXXXXX I attached the files but I am not sure if you can see the files as the site was not letting me to upload the last few times . Here are some of my follow up questions

(1) You mentioned prolonged treatment for many years, how many years could that be? Will there be any serious side effects. She has been on TB treatment for 2 years now, no serious side effects noticed.

(2) She was tested Negative for MDR TB in July 2015, is it likely for the bacteria to become MDR now while she has been on TB treatment?

(3) How can we collect the bacteria sample? Do we have to take it from the brain? Are there any other safer methods to collect the sample of the bacteria?

(4) 6 months back, my her head to the top of the car when the car went over a speed breaker. No blood or any serious injury, just pain for a few minutes. Could that be the factor for the increase in TB after she has shown improvement.

Please advise Doctor. Thank You.

doctor
Answered by Dr. Neeraj Kumar (18 hours later)
Brief Answer:
Get opinion of a pulmonologist too.

Detailed Answer:
Hello,
I have gone through your question and images of mri.
The quality of uploaded mri is not good but is suggestive of optochiasmatic arachnoiditis and increased basal exudates.
The duration of treatment can not be commented and can range for 3-4 years in present scenario.
The sample for bacterial testing is collected by lumbar puncture as had been done previously. No other safer method for brain tuberculosis.
Head injury is not related to worsening in tuberculosis.
Possibility of treatment related multi drug resistance can not be ruled out but difficult to prove.
Opinion from a pulmonologist dealing with MDR tuberculosis can be taken.
Hope you found the answer helpful.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Neeraj Kumar

Neurologist

Practicing since :2006

Answered : 2263 Questions

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What causes brain TB?

Brief Answer: Provide more details as asked Detailed Answer: Hello, I have gone through your question and understand your concern. Sometimes tuberculosis may paradoxically worsen after treatment due to rising immunity. The second possibility of MDR TB is ruled out with investigations. Brain tuberculosis and particularly tuberculoma or abscess may persist for many years requiring prolonged treatment. Such scenario is seen in about one third of tuberculosis patients. You can upload images of brain mri for review. The number of drugs is reduced after initial few months. Provide details regarding medicines too. If neck lymph node is responding then possibility of MDR TB is less likely. The diagnosis of TB can be accurately proven if bacteria is detected in sample. Hope you found the answer helpful. Regards Dr N Kumar Neurologist