Tuberculosis has been a pertinent public health problem for both developing and developed nations. For developed nations, military personal has the higher risk since they do travel to developing nations to embark on their duties. Cerebral tuberculosis is rare and if they occur, they tend to manifest as either meningitis or tuberculoma. Tinnitus is more likely in men particularly persons exposed to loud noises along with other causes. We present a case of cerebral tuberculosis induced tinnitus in a 26-year-old male army officer who presented with a one-week episode of convulsive crises and loss of consciousness after being exposed to a loud noise while on duty. Cranial MRI showed right temporo-parietal and left parietal finger-like hyper-signals with edema on Flair and T2. However, brain CT-scan showed right parieto-temporal and left parietal sub cortical hypodensities and finger-like borders without contrast re-uptake. There was strong suspicion for TB brain abscess leading to a possible manifestation of tinnitus in this patient.
A 26-year-old male army officer presented with chief complaints of convulsive crisis and loss of consciousness when he heard a loud noise while on duty. He fell to the ground and was found unconscious and drooling by a colleague. He was immediately transferred by non-medical means to our hospital for management. The patient experienced rigidity as well as uncontrolled muscle spasms leading to jerky motions which lasted for about one to two minutes and occurred two hours before admission in a non-febrile context. The convulsive crises occurred two hours prior to admission in a non-febrile state. The patient was then worked up for review of systems (ROS)- SpO2 was 98%; RR was 24 cpm, BP = 125/91 mmHg, Pulse =103 bpm, Glasgow coma scale = 15/15, isochoric iso-reactive pupils, blood sugar = 1,11 g/l; Temperature = 37°C. No motor or sensitive deficits, no meningeal signs, no former convulsive crisis, there was symmetry for chest movements, no signs of respiratory distress, resonant percussion sounds. Also, there was no urine incontinence, dysuria, scrotal swelling and external genitalia deformations. No peripheral lymph nodes (cervical, axillary, inguinal) were palpable.
Upon checking the labs, WBC: 5.05, HGB: 12.4 g/l, PLT: 313,000 electrolyte panel reveals all normal except moderate hypomagnesemia. HIV 1 and 2 serology was negative, Cardiovascular examination shows PPP, audible heart sounds at all four auscultation points, no MGR and RRR. On respiratory exam; there were no signs of distress, no tracheal deviation, resonant to percussion, CTAB and no CVAT. On abdominal exam; no HSM and normal bowel movement and sounds. Finally, Neurological; no acute distress (NAD), AAOx3, CN 2-12 intact, MME is normal, recall is 3/3, coordination and concentration intact, follows command and no motor or sensory deficits. Did bronchi fibroscopy along with broncho-alveolar lavage, in search of TB by PCR.
Tinnitus remains the second most prevalent service-connected disability. Patients with cerebral TB abscess are at increased risk for this condition.