Tuberculous and Fungal CNS Infections — WACS Viva & Clinical Scenarios (Central Nervous System Infections and Infestations)

Exam-style tuberculous and fungal cns infections viva scenarios with examiner probes and model answers for Neurosurgery candidates.

Scenarios covered

• SCENARIO 1: A 34-year-old human immunodeficiency virus negative patient presents with a 4-week history of low-grade fever, weight loss, progressive headache, altered sensorium, and right-sided ptosis with pupillary dilation. Non-contrast and contrast-enhanced cranial computed tomography demonstrates marked communicating hydrocephalus, profound basal cisternal leptomeningeal enhancement, and hypodensity within the left caudate nucleus. Discuss the clinical staging, diagnostic workup, medical therapy, and surgical strategy for managing hydrocephalus in this patient.
• SCENARIO 2: A 28-year-old male presents with severe mid-thoracic back pain, progressive weakness in both lower limbs over two weeks, urinary urgency, and a palpable mid-thoracic gibbus. Spinal magnetic resonance imaging confirms contiguous destruction of T6 and T7 vertebral bodies with relative disk involvement, anterior column collapse, a large prevertebral cold abscess, and posterior epidural compression causing thoracic myelopathy. Outline your systematic classification of Pott paraplegia, indications for urgent operative intervention, and the detailed surgical approach for anterior debridement, decomp
• SCENARIO 3: A 42-year-old woman is investigated for focal motor seizures of the left hand and progressive headache. Magnetic resonance imaging reveals a solitary 2.5 cm thick-walled ring-enhancing lesion in the right precentral gyrus with surrounding vasogenic oedema and a central hypointense core on T2-weighted sequences. Outline the differential diagnosis between tuberculoma, pyogenic brain abscess, and high-grade glioma, detailing the advanced neuroimaging findings and indications for stereotactic biopsy versus medical management.
• SCENARIO 4: A 52-year-old uncontrolled diabetic patient with ketoacidosis presents with acute right facial swelling, proptosis, complete ophthalmoplegia, necrotic black eschar on the hard palate, and rapid deterioration of consciousness. Cranial computed tomography reveals paranasal sinus opacification with bony erosion into the right orbit and anterior cranial fossa. Discuss the diagnosis, medical induction therapy, and emergency surgical debridement protocols for rhino-orbito-cerebral mucormycosis.
• SCENARIO 5: A 36-year-old immunocompromised adult presents with subacute severe diffuse headache, vomiting, and visual blurring. Cerebrospinal fluid opening pressure is 380 mmH2O, with positive Cryptococcal Antigen Lateral Flow Assay and India ink confirmation of Cryptococcus neoformans. Detail your stepwise protocol for antifungal induction therapy and the neurosurgical management of intractable raised intracranial pressure.