No CrossRef data available.
Article contents
Movement Disorders in Central Nervous System Tuberculosis: A Systematic Review
Published online by Cambridge University Press: 29 September 2025
Abstract
Background:
Tuberculosis (TB) affecting the central nervous system (CNS) can lead to a broad range of movement disorders, which are frequently overlooked in clinical settings. This review explores the various presentations, underlying mechanisms and patient outcomes related to these disorders.
Methods:
We systematically reviewed published case reports, series and cohort studies that described patients with CNS TB who developed movement disorders. Extracted data included patient characteristics, type of CNS TB, imaging and CSF findings, types of movement disorders, treatments used and outcomes.
Results:
A total of 61 patients with CNS TB and associated movement disorders were analyzed. The most common manifestations were ataxia, dystonia, chorea or hemiballismus and parkinsonism. Less frequent symptoms included opsoclonus-myoclonus, segmental myoclonus, tremors, cervical dystonia and stereotypy. TB meningitis was the predominant form, often accompanied by infarcts, hydrocephalus or tuberculomas. Proposed causes included vascular injury, inflammatory lesions, immune mechanisms and drug-related effects. All patients received anti-tuberculosis treatment, and nearly half required corticosteroids or surgical procedures. About 25 patients (41%) fully recovered, 17 (27.9%) had significant improvement, 13 (21.3%) showed partial improvement, 11 (18.0%) had ongoing problems and 1 (1.6%) died. Cohort studies also reveal that movement disorders – particularly tremors, dystonia, parkinsonism and ataxia – are frequent but underrecognized in CNS TB. These typically emerge early, often within three weeks, and are linked to lesions in the basal ganglia or thalamus.
Conclusions:
Movement disorders in CNS TB are more common than generally recognized. Prompt diagnosis through imaging and timely therapy can greatly improve neurological outcomes.
Résumé
Troubles du mouvement dans la tuberculose du système nerveux central : résultats d’une revue systématique.
La tuberculose (TB) du système nerveux central (SNC) peut se manifester par un large éventail de troubles du mouvement qui, bien souvent, passent inaperçus en clinique. La revue visait à relever les différentes manifestations de la maladie, les mécanismes sous-jacents et l’état de santé des patients en lien avec ces troubles.
L’équipe a procédé à un examen systématique d’exposés de cas, de séries et d’études de cohortes publiés, portant sur des patients atteints de la TB du SNC qui présentaient des troubles du mouvement. Les données extraites comprenaient les caractéristiques des patients, le type de TB du SNC, les résultats des examens par imagerie et des analyses du liquide céphalorachidien, les types de troubles du mouvement, les traitements et les résultats obtenus.
Au total, les dossiers de 61 patients atteints de TB du SNC qui présentaient des troubles du mouvement associés à la maladie ont fait l’objet d’analyse. Les manifestations les plus fréquentes étaient l’ataxie, la dystonie, la chorée ou l’hémiballisme et le syndrome parkinsonien. Des symptômes moins fréquents comprenaient l’opsoclonie-myoclonie, la myoclonie segmentaire, les tremblements, la dystonie cervicale et la stéréotypie. La forme la plus courante était la méningite tuberculeuse, qui s’accompagnait souvent d’infarctus, d’hydrocéphalie ou de tuberculomes. Parmi les causes envisagées, il y avait les lésions vasculaires, les lésions inflammatoires, les mécanismes immunitaires et les effets de certains médicaments. Les patients ont tous été soumis à un traitement antituberculeux, et presque la moitié d’entre eux ont dû recevoir des corticostéroïdes ou être opérés. Environ 25 patients (41 %) ont connu un rétablissement complet; 17 (27, 9 %), une amélioration importante de leur état et 13 (21,3 %), une amélioration partielle; 11 (18,0 %) ont fait face à problèmes persistants, et 1 (1,6 %) est mort. En outre, d’après les études de cohorte, les troubles du mouvement, notamment les tremblements, la dystonie, le syndrome parkinsonien et l’ataxie, sont fréquents, mais ils passent inaperçus dans la TB du SNC. Ces troubles apparaissent généralement tôt, souvent au cours des trois premières semaines de la maladie, et ils sont liés à des lésions des noyaux gris centraux ou du thalamus.
Les troubles du mouvement dans la TB du SNC sont plus fréquents que ne le laisse croire, en général, leur reconnaissance. Ainsi, la pose rapide d’un diagnostic par l’imagerie et la mise en route d’un traitement en temps opportun peuvent améliorer grandement les résultats neurologiques.
Information
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2025. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation
References
Garg, RK. Tuberculosis of the central nervous system: current concepts in diagnosis and treatment. Curr Opin Neurol. 2025;38(4):406–413. https://doi.org/10.1097/WCO.0000000000001358.Google Scholar
Seddon, JA, Tugume, L, Solomons, R, Prasad, K, Bahr, NC. Tuberculous meningitis international research consortium. The current global situation for tuberculous meningitis: epidemiology, diagnostics, treatment and outcomes. Wellcome Open Res. 2019;4:167. https://doi.org/10.12688/wellcomeopenres.15535.1.Google Scholar
Alarcón, F, Dueñas, G, Cevallos, N, Lees, AJ. Movement disorders in 30 patients with tuberculous meningitis. Mov Disord. 2001;16:890–894. https://doi.org/10.1002/mds.1185.Google Scholar
Alarcón, F, Maldonado, JC, Rivera, JW. Movement disorders identified in patients with intracranial tuberculomas. Neurologia. 2011;26(6):343–350. https://doi.org/10.1016/S2173-5808(11)70080-3.Google Scholar
Desai, S, Yadav, R, Garg, D, Schneider, SA, Pal, PK. Tuberculosis related movement disorders: a systematic scoping review highlighting geographic disparities, phenotypic patterns, treatment responses, and knowledge gaps in global reporting. Mov Disord Clin Pract. 2025;12(8):1043–1052. https://doi.org/10.1002/mdc3.70099.Google Scholar
Garg, RK, Pandey, S, Singhal, S, Mahdi, RA. Movement disorders in central nervous system tuberculosis: a systematic review of case reports, case series, and cohort studies. PROSPERO. 2025 CRD420251075389. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251075389.Google Scholar
Dian, S, Ganiem, AR, van Laarhoven, A. Central nervous system tuberculosis. Curr Opin Neurol. 2021;34(3):396–402. https://doi.org/10.1097/WCO.0000000000000920.Google Scholar
Marais, S, Thwaites, G, Schoeman, JF, et al. Tuberculous meningitis: a uniform case definition for use in clinical research. Lancet Infect Dis. 2010;10(11):803–812. https://doi.org/10.1016/S1473-3099(10)70138-9.Google Scholar
The Movement Disorder Society. About Movement Disorders: View clinical information, resources, tools and education about common movement disorders. Downloaded from (https://www.movementdisorders.org/MDS/About/Movement-Disorder-Overviews.htm) Assessed on 5th May, 2025.Google Scholar
Murad, MH, Sultan, S, Haffar, S, Bazerbachi, F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med. 2018;23:60–63. https://doi.org/10.1136/bmjebm-2017-110853.Google Scholar
Della Gatta, AN, Rizzo, R, Pilu, G, Simonazzi, G. Coronavirus disease 2019 during pregnancy: a systematic review of reported cases. Am J Obstet Gynecol. 2020;223:36–41. https://doi.org/10.1016/j.ajog.2020.04.013.Google Scholar
Valdes, LFI, Sibat, HF. Opsoclonus myoclonus ataxia syndrome associates to mixed meningitis responding to drug therapy: case report, new hypotheses and systematic review. J Drug Alcohol Res. 2025;14:162719. https://doi.org/10.4303/JDAR/236427.Google Scholar
Johansen, J. Cerebellar tremor caused by meningoencephalitis tuberculosis in a 17-year-old patient: a case report. Mutiara Med J Kedokt dan Kesehat. 2025;25(1):1–9. https://doi.org/10.18196/mmjkk.v25i1.Google Scholar
Gupta, D, Palayullakandi, A, Sopanam, S, Panda, PK, Sharawat, IK. Opsoclonus myoclonus ataxia syndrome: an atypical presentation of tuberculous meningitis. Am J Trop Med Hyg. 2025;112(4):856–858. https://doi.org/10.4269/ajtmh.24-0664.Google Scholar
Garg, RK, Rizvi, I, Kumar, N, et al. Acute hemichorea–hemiballismus in patients with tuberculous meningitis: an atypical manifestation of stroke. Neurol India. 2025;73(1):165–169. https://doi.org/10.4103/0028-3886.380255.Google Scholar
Vidhale, TA, Jaya, RP, Pande, M, Ganiyani, MA. A middle-aged patient living with HIV (PLHIV), presented with persistent hiccups, imbalance, and multifocal myoclonus secondary to disseminated tuberculosis. J Pediatr Neurol. 2024;21(2):103–105. https://doi.org/10.1055/s-0044-1783393.Google Scholar
Synmon, B, Siangshai, F, Nongrum, H, Wezah, W. CV junction drug-resistant tuberculosis presenting as acquired torticollis: a rare case presentation. Neurol India. 2024;72(3):687–688. https://doi.org/10.4103/neurol-india.Neurol-India-D-24-00062.Google Scholar
Qavi, A, Maurya, PK, Singh, AK, Kulshreshtha, D, Thacker, AK, Sikand, TS. Tongue tremor: a rare manifestation of disseminated central nervous system tuberculosis. Ann Mov Disord. 2024;7(2):147–148. https://doi.org/10.4103/aomd.aomd_34_23.Google Scholar
Jha, S, Tiwari, M, Chatterjee, D, Datta, A, Shobhana, A. Stereotypy and parkinsonism in tubercular meningitis: expanding the spectrum. Ann Mov Disord. 2024;7(2):125–127. https://doi.org/10.4103/aomd.aomd_20_23.Google Scholar
Garcia, JJB, Tecson-Delos Santos, CMA. Dancing out of step: a case of tuberculous meningitis presenting as childhood chorea. Tremor Other Hyperkinet Mov (N Y). 2024;14(1):17. https://doi.org/10.5334/tohm.871.Google Scholar
Sajjad, F, Baloch, MF, Ashraf, M, et al. Focal dystonia and ataxic hemiparesis as the initial presentation of a thalamic tuberculoma: a diagnostic challenge in an immunocompetent pediatric patient. Surg Neurol Int. 2023;14:350. https://doi.org/10.25259/SNI_581_2023.Google Scholar
Saishoji, Y, Mori, H, Izumi, Y. Cerebellar Ataxia caused by central nervous system tuberculosis with pulmonary tuberculosis: a case report. Cureus. 2023;15(1):e33493. https://doi.org/10.7759/cureus.33493.Google Scholar
Mukherjee, D, Mukherjee, A, Bhattacharya, S, Chakraborty, A, Pandit, A. Clinico-radiological evolution of CNS tuberculosis presenting as parkinsonism-predominant movement disorder. Acta Neurol Belg. 2023;123(1):319–321. https://doi.org/10.1007/s13760-022-02106-z.Google Scholar
Holla, VV, Netravathi, M, Kamble, N, Saini, J, Pal, PK. “Face of the giant panda” sign and bilateral thalamic hyperintensity in isoniazid-induced Ataxia. J Mov Disord. 2024;17(1):99. https://doi.org/10.14802/jmd.23112.Google Scholar
Dichoso, LP, Pagaling, G, Jamora, RDG, Anlacan, VMM. Case report: paroxysmal autonomic instability with dystonia syndrome: a rare complication of tuberculous meningitis. F1000Res. 2023;12:725. https://doi.org/10.12688/f1000research.132201.1.Google Scholar
Saini, AG, Hassan, I, Sharma, K, et al. Status dystonicus in children: a cross-sectional study and review of literature. J Child Neurol. 2022;37(6):441–450. https://doi.org/10.1177/08830738221079811.Google Scholar
Mahale, R, Pon, AG, Sandeep, M, Padmanabha, H, Mailankody, P, Pavagada, M. Levodopa non-responsive parkinsonism in tuberculous cerebral arteritis: a rare occurrence. Ann Indian Acad Neurol. 2022;25(3):519–520. https://doi.org/10.4103/aian.aian_1214_21.Google Scholar
Kalita, J, Misra, UK, Vibhute, A. Movement disorder in tuberculous meningitis. Neurol India. 2022;70(5):2196–2199. https://doi.org/10.4103/0028-3886.359206.Google Scholar
Dimal, NPM, Santos, NJC, Reyes, NGD, Astejada, MN, Jamora, RDG. Hemichorea-hemiballismus as a presentation of cerebritis from intracranial toxoplasmosis and tuberculosis. Tremor Other Hyperkinet Mov (N Y). 2021;11:2. https://doi.org/10.7916/d8-tfsy-bt19.Google Scholar
Alharbi, A, Khairy, S, Al Sufiani, F, Alkhani, A. Intracranial tuberculomas: a case report of clinical, radiological, and pathological characteristics. Int J Surg Case Rep. 2021;88:106477. https://doi.org/10.1016/j.ijscr.2021.106477.Google Scholar
Saini, AG, Sharma, R, Aneja, S, Sankhyan, N, Singhi, P. Infection-associated opsoclonus in children: a case series and review of the literature. J Neurovirol. 2020;26(3):338–47. https://doi.org/10.1007/s13365-020-00845-6.Google Scholar
Chouksey, A, Pandey, S. Blepharospasm with photophobia secondary to Midbrain tuberculoma and thalamic infarct. Neurologist. 2020;25(3):78–81. https://doi.org/10.1097/NRL.0000000000000265.Google Scholar
Boussetta, R, Zairi, M, Ben Sami, S, et al. Torticollis as a sign of spinal tuberculosis. Pan Afr Med J. 2020;36:277. https://doi.org/10.11604/pamj.2020.36.277.22977.Google Scholar
Tapiero, B, Décarie, JC, Crevier, L, Altit, G. An unexpected disease presenting as a pediatric cerebellar mass. Radiol Infect Dis. 2019;6(2):83–86. https://doi.org/10.1016/j.jrid.2019.06.001.Google Scholar
Gavigan, P, Hysmith, ND, Bagga, B. Case 2: Lethargy and ataxia in a 3-year-old girl. Pediatr Rev. 2019;40(4):194–196. https://doi.org/10.1542/pir.2017-0183.Google Scholar
Aasfara, J, Regragui, W, El Ouardi, L, Ben Haddou, EHA, Benomar, A, Yahyaoui, M. A case of bilateral thalamic infarct complicating tuberculous meningoencephalitis. Pan Afr Med J. 2019;33:2. https://doi.org/10.11604/pamj.2019.33.2.13327.Google Scholar
Franzini, A, Franzini, A, Levi, V, Cordella, R, Messina, G. An unusual surgical indication for cerebral tuberculosis: status dystonicus. Case report. Acta Neurochir (Wien). 2018;160:1355–1358. https://doi.org/10.1007/s00701-018-3555-0.Google Scholar
Pandey, S, Singh, AS. Unilateral parkinsonism: symptomatic of brain tuberculoma. Neurologist. 2017;22(3):80–81. https://doi.org/10.1097/NRL.0000000000000114.Google Scholar
Deepesh, A, Pendharkar, HS. Isoniazid toxicity presenting as bilateral dentate hyperintensities. Neurol India. 2017;65(5):1193. https://doi.org/10.4103/neuroindia.NI_249_17.Google Scholar
Parralo, A, Lopez, A, Giraldo, N, Bravo, JJ, Valencia, C, Hernandez, A. Cerebral and cerebellar tuberculomas in a 78-year-old woman: a case report. Eur J Neurol. 2015;22:510. https://doi.org/10.1111/ene.12808.Google Scholar
Pinto, MV, Aguiar, T, Nogueira, R, Dias, AC, Rosso, AL. Hemichorea in tuberculous meningitis. Arq Neuropsiquiatr. 2014;72(2):160. https://doi.org/10.1590/0004-282X20130230.Google Scholar
Sahu, R, Patil, TB, Kori, P, Shukla, R. Isolated thalamic tuberculoma presenting as ataxic hemiparesis. BMJ Case Rep. 2013;2013:bcr2013009100. https://doi.org/10.1136/bcr-2013-009100.Google Scholar
Singh, DK, Singh, N. Paroxysmal autonomic instability with dystonia in a child: rare manifestation of an interpeduncular tuberculoma. Pediatr Neurosurg. 2011;47(4):275–278. https://doi.org/10.1159/000334276.Google Scholar
Garg, RK, Singh, SK, Malhotra, HS, Singh, MK. Bobble-head doll syndrome in a patient with tuberculous meningitis. BMJ Case Rep. 2012;2012:bcr2012006663. https://doi.org/10.1136/bcr-2012-006663.Google Scholar
Chakor, RT, Rajadhyaksha, GC. A young adult with progressive limb shaking and slowness. J Postgrad Med. 2011;57(3):231–6. https://doi.org/10.4103/0022-3859.85221.Google Scholar
Ashraf, VV, Praveenkumar, Sureshkumar, EK, Anand, R, Kuruvilla, S, Girija, AS. Segmental myoclonus and marked ataxia in a patient of pulmonary tuberculosis. Neurol India. 2011;59(6):904–906. https://doi.org/10.4103/0028-3886.91376.Google Scholar
Prashantha, DK, Pal, PK, Bharath, RD. Hyperventilation-induced painful tonic spasms secondary to a structural lesion of the pons. Parkinsonism Relat Disord. 2010;16(9):618–619. https://doi.org/10.1016/j.parkreldis.2010.07.005.Google Scholar
Krygowski, JD, Brennen, DF, Counselman, FL. Intracranial tuberculomas: an unusual cause of altered mental status in a pediatric patient. J Emerg Med. 2010;38(3):323–327. https://doi.org/10.1016/j.jemermed.2007.12.040.Google Scholar
Gujjar, A, Al-Mamari, A, Jacob, PC, Jain, R, Balkhair, A, Al-Asmi, A. Extrapontine myelinolysis as presenting manifestation of adrenal failure: a case report. J Neurol Sci. 2010;290(1–2):169–171. https://doi.org/10.1016/j.jns.2009.11.012.Google Scholar
Donmez, FY, Coskun, M, Guven, G. Medulla oblongata tuberculoma mimicking metastasis presenting with stroke-like symptoms. Neurol Sci. 2009;30(4):349–352. https://doi.org/10.1007/s10072-009-0099-6.Google Scholar
Avila, A, Berrade, J. Tuberculosis involving bilateral middle cerebellar peduncles and the brainstem. AJNR Am J Neuroradiol. 2009;30(8):E119. https://doi.org/10.3174/ajnr.A1682.Google Scholar
Mridula, KR, Alladi, S, Varma, DR, et al. Corticobasal syndrome due to a thalamic tuberculoma and focal cortical atrophy. J Neurol Neurosurg Psychiatry. 2008;79(1):107–108. https://doi.org/10.1136/jnnp.2007.131532.Google Scholar
Ozer, F, Meral, H, Aydemir, T, Ozturk, O. Hemiballism–hemichorea in presentation of cranial tuberculoma. Mov Disord. 2006;21(10):1771–1773. https://doi.org/10.1002/mds.21055.Google Scholar
Alkhani, A, Al-Otaibi, F, Cupler, EJ, Lach, B. Miliary tuberculomas of the brain: case report. Clin Neurol Neurosurg. 2006;108(4):411–414. https://doi.org/10.1016/j.clineuro.2005.04.012.Google Scholar
Tey, HL, Seet, RCS, Lim, ECH. Tuberculomas causing cervical dystonia. Intern Med J. 2005;35(4):261–262. https://doi.org/10.1111/j.1445-5994.2005.00708.x.Google Scholar
Poonnoose, SI, Singh, S, Rajshekhar, V. Giant cerebellar tuberculoma mimicking a malignant tumour. Neuroradiology. 2004;46(2):136–139. https://doi.org/10.1007/s00234-003-1100-z.Google Scholar
Kalita, J, Ranjan, P, Misra, UK, Das, BK. Hemichorea: a rare presentation of tuberculoma. J Neurol Sci. 2003;208(1-2):109–111. https://doi.org/10.1016/S0022-510X(02)00417-3.Google Scholar
Alarcón, F, Tolosa, E, Munoz, E. Focal limb dystonia in a patient with a cerebellar mass. Arch Neurol. 2001;58(7):1125–1127. https://doi.org/10.1001/archneur.58.7.1125.Google Scholar
Chaudhary, N, Ravat, SH, Shah, PU. Phenytoin induced dyskinesia. Indian Pediatr. 1998;35(3):274–276.Google Scholar
de la Fuente-Aguado, J, Bordón, J, Moreno, JA, Sopeña, B, Rodriguez, A, Martínez-Vázquez, C. Parkinsonism in an HIV-infected patient with hypodense cerebral lesion. Tuberc Lung Dis. 1996;77(2):191–192. https://doi.org/10.1016/S0962-8479(96)90013-1.Google Scholar
Tang, PS, Low, LCK. Radiological and clinical features of basal ganglia infarction in tuberculous meningitis. Aust Paediatr J. 1989;25(6):361–362. https://doi.org/10.1111/j.1440-1754.1989.tb02237.x.Google Scholar
Verma, A, Tandon, PN, Maheshwari, MC. Trismus caused by paradoxical activity of jaw-closing muscles in brain stem tuberculoma. Oral Surg Oral Med Oral Pathol. 1988;65(6):675–678. https://doi.org/10.1016/0030-4220(88)90007-2.Google Scholar
Babikian, VL, Heydemann, PT, Swisher, CN. Extrapyramidal movements in a patient with tuberculous meningitis: an early clue to diagnosis. Clin Pediatr (Phila). 1985;24(2):113–115. https://doi.org/10.1177/000992288502400208.Google Scholar
Sandyk, R. Hemifacial spasm in tuberculous meningitis. Postgrad Med J. 1983;59(695):570–571.Google Scholar
Riela, A, Roach, ES. Choreoathetosis in an infant with tuberculous meningitis. Arch Neurol. 1982;39(9):596. https://doi.org/10.1001/archneur.1982.00510210028008.Google Scholar
Slot, GJ, Morris, D. Erythema nodosum associated with chorea and tuberculous meningitis. Lancet. 1939;233(6028):571–572. https://doi.org/10.1016/S0140-6736(00)73744-5.Google Scholar
Jackson, JH. On choreal movements and cerebellar rigidity in a case of tubercular meningitis. Br Med J. 1875;1(750):636–637. https://doi.org/10.1136/bmj.1.750.636.Google Scholar
Pandey, CS, Kumar, R, Malhotra, HS, Kohli, N, Kumar, C, Verma, SK. Movement disorders in children: an observational study in a tertiary care center in North India. J Pediatr Neurol. 2019;17(3):131–138. https://doi.org/10.1055/s-0039-1693030.Google Scholar
Netravathi, M, Pal, PK, Devi, BI. A clinical profile of 103 patients with secondary movement disorders: correlation of etiology with phenomenology. Eur J Neurol. 2012;19(2):226–233. https://doi.org/10.1111/j.1468-1331.2011.03469.x.Google Scholar
Misra, UK, Kalita, J, Maurya, PK. Stroke in tuberculous meningitis. J Neurol Sci. 2011;303(1–2):22–30. https://doi.org/10.1016/j.jns.2010.12.015.Google Scholar
Rock, RB, Olin, M, Baker, CA, Molitor, TW, Peterson, PK. Central nervous system tuberculosis: pathogenesis and clinical aspects. Clin Microbiol Rev. 2008;21(2):243–261. https://doi.org/10.1128/CMR.00042-07.Google Scholar
Lee, JK, Oh, CH, Park, HC, Yoon, SH. Grisel’s syndrome induced by mycobacterium tuberculosis. Korean J Spine. 2015;12(2):84–87. https://doi.org/10.14245/kjs.2015.12.2.84.Google Scholar
Alarcón, F, Giménez-Roldán, S. Systemic diseases that cause movement disorders. Parkinsonism Relat Disord. 2005;11(1):1–18. https://doi.org/10.1016/j.parkreldis.2004.10.003.Google Scholar
Garg et al. supplementary material 1
Garg et al. supplementary material
File
29.1 KB
Garg et al. supplementary material 2
Garg et al. supplementary material
File
41 KB
Garg et al. supplementary material 3
Garg et al. supplementary material
File
58.6 KB