Intracranial tuberculosis in children: CT appearance and clinical outcome

Abstract

We retrospectively evaluated the CT studies of 9 children who presented with intracranial tuberculosis during 1981-1987, and compared their radiographic appearance with the clinical outcome. The most common radiographic findings were: 1) ventriculomegaly (7/9) ,2) tuberculoma formation (6/9), and 3) infarction (4/9). Of 7 patients with ventriculomegaly, 3 required a ventricular shunt and 2 had spontaneous resolution of ventricular dilatation. Four children with ventriculomegaly were moderately or severely retarded, one had cognitive dysfunction, and one was neurologically normal. Four of six children with tuberculoma also had infarction and/or ventriculomegaly; of these four children, three were moderately or severely retarded. Two patients with tuberculoma as the only intracranial abnormality had complete resolution of the granuloma with normal neurologic outcome following antituberculous therapy. The four children with large vessel infarction also had ventriculomegaly; three had poor clinical outcome. The presence of tuberculoma alone is not necessarily predictive of poor neurologic outcome; age less than 20 months, infarct, and/or ventriculomegaly are usually associated with sequelae.

Neurocysticercosis (NCC) vs Central Nervous System (CNS) Tuberculoma in Children—Dilemma over Clinico-Radiological Diagnosis?

“…It was noticed that few fresh lesions appeared during the treatment [9]. There was complete resolution of tuberculomas in many cases leaving few with other associated findings [10].…”

Central Nervous System Tuberculosis

“…The meningeal enhancement can extend over the surface of the brain convexities, along tentorium and the sylvian fissures. 6,7 Isolated sylvian fissure involvement by tuberculous meningitis is also known. 10 Extension into the ventricular system may cause ependymitis (abnormal enhancement of ventricular linings), or choroid plexitis (enlarged, enhancing choroid plexus).…”

Radiologic and Clinical Findings in Tuberculous Meningitis

“…Cough and fever are common symptoms in patients (4). All patients in this study had fever and cough.…”

“…Contrast enhanced magnetic resonance imaging (MRI) is more sensitive than CT for the detection of ischemic changes, edema secondary to inflammation and basal meningeal inflammation (3)(4)(5).…”