Magnetic Resonance Imaging in Intracranial Tuberculosis

Abstract

Tuberculosis (TB) is still a major cause of serious illness in many parts of the world. Intracranially, TB manifests itself variably as meningitis, tuberculoma and tubercular abscess [II. Although its appearance on MR is not absolutely specific, it is important in the proper clinical setting to recognize the range of possible patterns that can be observed on images £2]. Magnetic Resonance Imaging (MRI) has emerged as a quality imaging tool aiding in the diagnostic evaluation of intracranial TB variably displaying meningeal, parenchymal, osseous and craniovertebrallesions. The MRI characteristics of 18 cases of intracranial TB were reviewed. Results: Multiple lesions occured with a slightly higher incidence at 61 %. In all, 11 patients (61 %) presented with meningitis. Meningeal lesions without parenchymal or vascular involvement were seen in 16% of cases. 2 patients had extension of enhancing exudates into the spinal subarachnoid spaces. While 6 patients had focal intra-axial tuberculomas, representing 33% cases, 3 patients presented with infarcts. 1 patient presented with haemorrhagic infarct at right middle cerebral artery territory while two other showed multiple small infarcts. Hydrocephalus was identified in 4 patients and epidural lesions were noted in 2 cases. MRI should be considered as the imaging modality of choice for patients with suspected intracranial TB.

Avoiding Anchoring Bias in the Times of the Pandemic!

“…The mortality in tuberculous meningitis remains exceptionally high. Clinical response to anti-tubercular treatment in all forms of CNS tuberculosis is contingent on an early diagnosis before irreversible neurological deficit occurs; therefore, the management strategy should involve an early diagnosis coupled with aggressive treatment [ 11 , 12 ]. The culture from the CSF analysis confirmed tuberculous infection 3 weeks later.…”

Pachymeningeal en Plaque Tuberculoma in Children: A Case Report

“…On CT scan, they appear as dural based variably enhancing lesion with or I. Berete et al Open Journal of Modern Neurosurgery without calcification, and often associated with active communicative hydrocephalus [12]. MRI is the investigation of choice and usually shows a hypointense lesion on T1 weighted, and a hypointense lesion with surrounding hyperintense edema on T2-weighted and enhances well with gadolinium contrast [4] [13]. In our case the lesion was multifocally infiltrating the brain parenchyma, and the enhancement pattern was heterogenous, but the dural insertion, the calcifications, the edema and the hydrocephalus were present.…”

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

“…In each subtype, small tubercular lesions known as Rich foci initially develop in the CNS, either in the meninges, brain, or spinal cord, and become active after a quiescent period (1,2) via distant hematogenous spread with low-level bacteremia (2). The imaging findings of parenchymal miliary tuberculomas have been described in only a few case reports and research articles (1,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17), published mostly from developing countries. It has been reported that intraparenchymal tuberculomas occur in the frontal and parietal lobes in adults, in contrast to the infratentorial region in children (10).…”