Problems in the Diagnosis of Tuberculous Meningitis

Tuberculous meningitis is uncommon in North America. A review of all cases of acute tuberculous meningitis seen at the Vancouver (British Columbia) General Hospital (VGH), Canada, during the decade 1970 to 1980 showed several important difficulties currently encountered in making the diagnosis of tuberculous meningitis. SUBJECTS AND METHODS All cases of tuberculous meningitis recorded by the Medical Records Department and laboratory of VGH were reviewed. The only patients excluded were those without active disease who were admitted for treatment of the sequelae of tuberculous meningitis. The 15 patients in this study included nine with positive CSF cultures for Mycobacterium tuberculosis , two where the organism was isolated from the respiratory tract but not from the CSF, and one that was diagnosed post mortem by the demonstration of acid-fast bacilli in brain sections. The remaining patients were considered to have tuberculous meningitis on the basis of clinical findings and response to treatment.