What causes recurrent lesions in the brain despite treating brain tuberculosis?

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Posted on Mon, 18 Sep 2017 in Headache and Migraines
Question: Hello Doctors,

My mom has been diagnosed with lymph node and brain TB 2 years back and has been on TB medication since then. She had a lung TB 5 years back and was cured.

4 months back she had a MRI scan which suggested the lesions/ scars in the brain has increased. The doctors then recommended to under go a PET scan. After looking at the PET scan results, the doctors said that the TB bacteria is completely gone and these scars/lesions were caused due to TB occurrence and will take time for them to reduce .

The doctor also suggested to continue with the TB meds for 3/4 months and then stop as the TB bacteria is gone

(1) Is it common for the scars/lesions to exist after the TB bacteria is cured?
(2) How long does it take for the lesions/scars to go?
(3) Is it OK to discontinue the TB meds while the lesions or scars are still there even though the TB bacteria is gone.

Please advise. Thank You.
doctor
Answered by Dr. Neeraj Kumar 1 hour later
Brief Answer:
Stop drugs when advised and be in constant follow up

Detailed Answer:
Hello,
I have gone through your question and understand your concern.
Tuberculoma of brain is slow to response with drug. The lesion usually persists for years.
The duration of ATT is in year's and depends upon clinical condition and imaging findings.
In case of inactive lesion, drugs can be stopped with regular follow up thereafter.
Scar or gliotic lesion may persist and doesn't require further therapy. It doesn't disappears but persists.
You can upload the images and send a link to me to view the images.
Hope you found the answer helpful.
Do get back to me for further information.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Neeraj Kumar 39 hours later
Thank You for your response, Doctor. I have a few follow up questions

(1) How often should we follow up with the neurologist and are there any kind of tests we should perform every few months?
(2) Can the lesions/scars increase during treatment even after the TB infection is cured?
(3) What tests tell you accurately that there is no more TB infection? We did a PET scan based on which the Dr. said that there is no more infection, are there any other tests?

Please advise. Thank You

doctor
Answered by Dr. Neeraj Kumar 19 hours later
Brief Answer:
Be in regular follow up, upload images

Detailed Answer:
Hello,
You should have a follow up 6 monthly after stopping drugs.
Imaging needs to be seen before commenting about the enlargement of lesion.
Healed lesions are very unlikely to grow again.
PET scan is a new modality for assessing the activity in lesion but is not 100% diagnostic.
Sadly, no other investigation modality exist to answer this query. Regular follow up is required and investigation only if the treating doctor feels necessary.
Hope you found the answer helpful.
Wishing good health and early recovery.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
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Dr. Neeraj Kumar

Neurologist

Practicing since :2006

Answered : 2263 Questions

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