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How long should my sister take steroids for brain tuberculosis?

Q: My 44 years old sister has been diagnosed with brain tuberculosis (TB) and neurocysticercosis. The doctor started with anti-tuberculosis treatment (ATT) even though Mantoux test and chest x-ray showed no evidence of TB. However, her ESR was 30 mm (1st hr). Should my sister continue taking steroids and sodium valproate and if yes, for how long?

A:A number of times there maybe diagnostic dilemma between neurocysticercosis and tuberculosis as both can give rise to similar looking shadows(ring enhancing lesions)on MRI with subtle differences. In case of cysticercosis, deworming medication is not always indicated and anti-epileptic medication and steroids maybe given. However, tuberculosis needs specific antitubercular medication apart from antiepileptics and steroids, Hence whenever there is a doubt, most neurologists would prefer to give tb medication. Mantoux and chest xray maybe normal.The minimum duration of therapy is one to one and a half years with taperig doses of steroids in the initial months only. Antiepileptics are continued longer.

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