Extensive perivascular dissemination of cerebral miliary tuberculomas: a case report and review of the literature

Abstract

Cerebral tuberculosis (TB) presents most frequently as meningitis in the basilar cistern; however, it can also manifest in various other ways, such as localized encephalitis, abscess, and tuberculoma. Here, focusing on imaging findings, we report an immunocompetent case who demonstrated multiple parenchymal lesions and was diagnosed with cerebral TB after testing positive on QuantiFERON (QTF); her clinical signs/symptoms and laboratory findings responded well to anti-TB medication therapy. The patient was a 60-year-old woman with the chief complaints of headache and consciousness disturbance. On admission, cerebrospinal fluid (CSF) examination showed increased monocyte predominance. T2-weighted images showed multiple, widely distributed hyperintense lesions in the periventricular and deep white matter. Gadolinium-enhanced three-dimensional gradient echo T1-weighed images revealed numerous granules or faint, small, enhanced foci in lesions in the periventricular and deep white matter, central gray matter, and hippocampus. Some abnormal sulcal enhancement was detected in the pia mater, indicating meningitis. Clinically, the diagnosis was difficult to make, but as the QTF result was positive, anti-TB drugs were administered, after which both the symptoms and CSF cell count showed improvement.

Unusual presentation of miliary tuberculosis in a 12-year-old girl: a case report

“…Delayed diagnosis in miliary TB patients can cause serious complications including cranial nerve involvement, convulsions and death [ 16 ] as a seizure occurred in our case. Machida et al’s report showed 1% of TB patients had CNS involvement which is about a high mortality rate and permanent neurological sequelae [ 33 ]. Fortunately, in the present case, follow-up interventions showed no neurological sequelae and she was in good general condition.…”

Miliary brain tuberculosis in an infant

“…In adults, intraparenchymal tuberculomas TB often appears in the frontal and parietal lobes; however, the infratentorial region is more commonly affected in children [7] . The imaging findings of brain miliary tuberculomas on MRI include tuberculosis that are often smaller than 2.5 cm in diameter, hypointense lesions on T1-weighted image (T1W), hypo- or hyperintense lesions on T2-weighted image (T2W), with a central hypointensity on T2W and homogeneous enhancement in the initial stage and ring enhancement in the late stage [7] . In our case, MRI showed diffuse miliary lesions smaller than 2 mm in diameter, with homogeneous enhancement in the cerebral parenchyma.…”

Multifocal Tuberculosis with Prolonged Paradoxical Reaction

“…Machida et al, 2018 [16] Brain A patient diagnosed with tuberculous meningitis and multiple periventricular tuberculomas. One month after initiation of anti-TB therapy, tuberculomas increased in number and size.…”