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Abstract Introduction Tuberculosis of the central nervous system (CNS) remains endemic in developing countries with high morbidity and mortality despite advances in imaging and treatment. The objective of our work was to describe the diagnostic and therapeutic difficulties of this pathology in the context of a country with limited health resources. Materials and methods We retrospectively studied 8 cerebral tuberculosis abscess files, collected in the archives of the neurosurgery department of the Conakry University Hospital over a 5-year period (January 2013–December 2017). The diagnosis was made by scanning and by isolation of acid-fast bacilli (AFB) by direct examination of pus. Results Mean age was 33 years (9–56 years), sex, 5H 5 men/3F 3 women. History of pulmonary TB, 3 cases; TB contagious, 5 cases; TST ITR positive, 5 cases; associated visceral TB, 5 cases; HIV positive serology, 2 cases. The clinic was dominated by altered consciousness, 7 cases; focal signs, 7 cases; and fever, 5 cases. The site was hemispherical in 7 cases and one case in the posterior brain fossa. Treatment was medico-surgical in all patients. The evolution was favorable in 3 cases, the neurological sequelae in 3 cases, 2 cases of death, and 2 cases of recurrence. Conclusion Cerebral tuberculous abscesses constitute a medico-surgical emergency. Despite their rarity, morbidity and mortality remains high in the context of developing countries due to diagnostic and therapeutic delays.

Background: The diagnostic certainty of medullar tuberculosis (TB) without Pott disease is difficult to establish in a tropical environment with the large group of infectious, parasitic, and systemic myelopathies, despite the increasing availability of magnetic resonance imaging (MRI) data and improvement of biological exploration platforms. Methods: We retrospectively analyzed the files of 186 patients hospitalized in the Department of Neurology and Neurosurgery of the University Hospital Center of Conakry, Guinea, between 2008 and 2016 for the management of non-compressive and compressive myelopathy. Biological evidence of TB infection was demonstrated for 13 (6.9%) patients. Results: Infectious clinical picture prior to the development of neurological signs was reported in 11 patients (84.6%). The neurological signs were summed up by the existence of a sensitivo-motor semiology of progressive evolution (100% of cases) with sphincter disorders in 11 patients (84.6%) and a medullary compression symptomatology with a lesion and under lesion syndrome from the outset in 4 patients (30.8%). Medullary MRI revealed an extensive intramedullary hypersignal in 9 patients with non-compressive myelopathy and in 4 cases, the lesions appeared in T1 hypersignal and T2 isosignal were localized. Lumbar puncture (LP) revealed lymphocytic pleocytosis, hypoglucorrhage (0.3 to 0.5 g/l), and leukocytosis. Conclusion: This study reveals a classic clinical, biological, neuroradiological, and evolutionary profile of compressive and non-compressive myelopathies. These results are important for the therapeutic and evolutionary discussion of TB myelopathies for good management. [ABSTRACT FROM AUTHOR]