Tuberculosis of the central nervous system: recognition, diagnosis and treatment in a low-prevalence country.

Tuberculosis (TB) is one of the greatest threats to global public health, with 9.2 million new cases in 20061 and has become increasingly common in the UK. Central nervous system (CNS) infection with Mycobacterium tuberculosis (MTB) is relatively rare but is associated with a serious risk of neurological morbidity or death. Delays in diagnosis worsen prognosis and even with anti-tuberculous therapy up to 30% of tuberculous meningitis (TBM) patients may die.2 TBM and tuberculomas can mimic other CNS pathologies. Careful analysis of the clinical features, CSF examination and pragmatic use of diagnostic tests can aid the diagnosis. Prolonged anti-tuberculous treatment is required and presumptive treatment should not be delayed for microbiological confirmation of the disease.