Radiologic and Clinical Findings in Tuberculous Meningitis

Abstract

We aimed to evaluate the radiologic and clinical findings of patients with tuberculous meningitis encountered during a 4-year period, retrospectively. Sixteen patients with tuberculous meningitis were admitted to our hospital. The diagnosis was based on abnormal neurologic symptoms and signs, cerebrospinal fluid findings, negative bacteria culture, and abnormalities on brain-imaging studies. CT and MR examinations were performed in 16 and 9 patients, respectively. A retrospective comparison was done between CT and MR findings. All patients had fever, lethargy, and some of them had cough. Neurologic presentations included increased intracranial pressure, vomiting, seizures, paresis, nuchal rigidity, and disturbance of consciousness. Acid-fast stain of cerebrospinal fluid for tuberculous bacilli was negative for all samples. All bacterial cultures of cerebrospinal fluid yielded no growth, with the exception of one that grew Mycobacterium tuberculosis. Radiologic findings compatible with tuberculous meningitis including hydrocephalus, basilar cistern enhancement and infarction was observed more clearly on MR than CT. Early diagnosis in tuberculous meningitis may prevent neurologic damage. Imaging studies is an important part of diagnosis and MR imaging should be performed as a first choice of imaging modalities in patients with tuberculous meningitis.

Pulmonary tuberculosis with meningitis in a 7-month-old infant

“…Contrast enhanced CT is of diagnostic aid as it can identify exudates in basal cisterns and basal meningeal inflammation. The most significant benefit of CT is the detection and assessment of associated complications such as hydrocephalus, cerebral infarcts and tuberculomas [6]. Magnetic resonance imaging gives better visualization of the base of the brain as well as enhanced delineation of ischaemic areas [1].…”

“…Magnetic resonance imaging gives better visualization of the base of the brain as well as enhanced delineation of ischaemic areas [1]. Contrast enhanced magnetic resonance imaging is more sensitive than CT for the detection of ischemic changes, edema secondary to inflammation and basal meningeal inflammation [6].…”

“…Its presentation is often nonspecific, early recognition of this potentially treatable disease remains a challenge to clinicians. Therefore, the most important concern of the clinician is to diagnose and treat TBM as soon as possible [6].…”

Mri Evaluation of Intracranial Complications of Tuberculosis.

“…Tuberculosis of the central nervous system accounts for approximately 5-10% of extrapulmonary cases of TB [2]. Tuberculous meningitis (TBM) is the most life-threatening form of extrapulmonary tuberculosis and neuro-tuberculosis is the most common presentation [3]. It is common in young children but can also occur in HIV infected adults.…”

Incidence and Presentation of Tuberculous Meningitis

“…Initial management includes airway management , maintaining circulation assessing GCS and management of fever and broad spectrum antibiotic therapy until unless culture sensitivity is obtained. [4][5][6] All patients presented in emergency department or outpatient door of study institution with signs and symptoms of meningitis were evaluated and out of them patients with tuberculous meningitis were selected for study. These cases were belonging to both male and female populations and having different age groups.…”