Tuberculosis Meningitis

The combination of space-occupying lesions, high CSF protein, low CSF glucose and CSF lymphocytosis point to this case being tuberculosis meningitis with cerebral tuberculomas. The organism is not seen on microscopy in 20-50% of cases. Cryptococcal meningitis can give a similar picture, although the protein and glucose changes are not usually so marked; cerebral cryptococcomas are uncommon and the organism is normally seen on microscopy in patients as ill as this. Toxoplasmosis, syphilis and lymphoma would not cause such significant changes in the protein, glucose or white cell count.