Clinical Profile and Prognostic Determinants in Central Nervous System Tuberculosis: An Observational Study from a Tertiary Neurology Centre in India

Background and objectives Central nervous system tuberculosis (CNS TB) is a major cause of neurological morbidity in developing countries, with diverse clinical presentations. This study aimed to characterize the demographic and clinical profile of patients with CNS TB at a tertiary neurology center in India and to identify key clinical, laboratory, and radiological predictors of prognosis. Methods A prospective observational study was conducted between August 2023 and January 2025 on 110 patients with CNS TB at a tertiary care center. Demographic, clinical, neuroimaging, cerebrospinal fluid (CSF), systemic laboratory data, and cartridge-based nucleic acid amplification test (CBNAAT) findings were analyzed. Functional outcome was assessed using the modified Rankin Scale at the 9-month follow-up. Results Of 110 patients, 56.4% were female; the mean age was 29.86 ± 11.23 years, with 84% being younger than 40 years. Common features included meningeal signs (92.7%), headache (90.9%), fever (88.2%), altered sensorium (83.6%), and seizures (33.6%). Cranial nerve palsies occurred in 28.2% patients, mainly the sixth nerve. Pulmonary TB was present in 23.6% patients. Neuroimaging showed tuberculomas (37.3%), hydrocephalus (27.3%), infarcts (20%), and basal exudates (11.8%). CSF analysis revealed lymphocytic pleocytosis (mean 173 cells/mm³), elevated protein (182.7 mg/dL), and low glucose (mean CSF/plasma ratio 0.31). CBNAAT was positive in 18.2% subjects, with 16.36% being rifampicin-sensitive and rifampicin resistance was observed in 0.9%. Poor outcome was associated with increasing age, longer duration of illness, cranial neuropathy, hydrocephalus, and paradoxical reaction. Conclusions CNS TB in our cohort predominantly affected young adults and presented with classical meningeal features and diverse neuroimaging abnormalities. Microbiological confirmation remained limited, underscoring reliance on clinical-radiological diagnosis. Poor outcome was associated with increasing age, longer duration of illness, cranial neuropathy, hydrocephalus, and paradoxical reaction.