Presentations and outcomes of central nervous system TB in a UK cohort: The high burden of neurological morbidity

•Patterns of clinical presentation TB meningitis are diverse. •Diagnostic criteria for possible, probable & definite mass lesions proposed. •Seizures a more frequent in patients with lesions. •Neurological sequelae common: occurring about third CNS-TB survivors. Objectives Most data Central Nervous System Tuberculosis (CNS-TB) derive from high-incidence, resource-limited countries. We sought to determine the presentation, management and outcomes low-incidence setting accessible healthcare. Methods undertook retrospective, observational study adults at single tertiary-referral London hospital (2001–2017). Cases were categorised as either (TBM) or without (TBML), applying novel definite, probable, possible TBML. Results identified sixty-two cases TBM (37% definite; 31% probable; 32% possible) alongside 14 TBML (36% 29% 36% possible). Clinical was highly variable. Among CSF parameters, hypoglycorrhachia proved most discriminatory “definite” TBM. Neurosurgical intervention required mass-effect hydrocephalus 16%. Mortality higher versus (16% vs. 0%) but overall morbidity significant; 33% survivors suffered persisting neurological disability 12-months. In TBM, hydrocephalus, infarct, basal enhancement low white cell count independently associated worse outcomes. Conclusion Although mortality lower than previously reported other settings, significant, highlighting need improved diagnostics, therapeutics interventions mitigate sequelae.