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Global Renal Ischemia
Joseph Junewick, MD FACR
over 4 years ago
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Tuberculous Meningitis

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 6 years ago
Updated: over 6 years ago
Tags: PEDS
Modality/Study Types: MR CT
Activities:
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History

14 month old with fever and increasing lethargy.


Case Images


Diagnosis

Tuberculous Meningitis

Clinical Notes

Grandmother with active tuberculosis.

Findings

CT – Basal leptomeningeal enhancement with mild ventriculomegaly.

MR – Basal leptomeningeal enhancement with mild ventriculomegaly.

Discussion

Tuberculosis can affect virtually any organ system in the body and can be devastating if left untreated. Most tuberculous infections of the central nervous system are a result of hematogenous spread. Intracranial tuberculosis results in two related pathologic processes: tuberculous meningitis and intracranial tuberculomas. Tuberculous meningitis is a more frequent manifestation of neurotuberculosis than is brain tuberculoma and is more commonly seen in children.

Meningeal involvement manifests as homogeneous enhancement most pronounced in the basal cisterns. There may be involvement of the meninges within the sulci over the cerebral convexities and in the sylvian fissures. Abnormal enhancement of the choroid plexus and ependymal lining of the ventricular system may rarely be seen. Sequelae of tuberculous meningitis include focal areas of atrophy secondary to infarcts and hydrocephalus and, rarely, syringomyelia or syringobulbia.

The differential diagnosis for tuberculous meningitis includes other infectious agents (nontuberculous bacteria, viruses, fungi, parasites), noninfectious inflammatory disease affecting the leptomeninges (rheumatoid disease, sarcoidosis), and primary or secondary neoplastic involvement of meningeal surfaces (meningiomatosis, neoplastic meningitis from a peripheral tumor source, cerebrospinal fluid seeding from a primary tumor of the central nervous system).

Reference

Andronikou S, Wilmshurst J, Hatherill M, VanToorn R. Distribution of brain infarction in children with tuberculous meningitis and correlation with outcome score at 6 months. Pediatr Radiol (2006); 36:1289-1294.

Harisinghani MG, McCloud TC, Shepard JO, Ko JP et al. Tuberculosis from Head to Toe. Radiographics (2000); 20:449-470.



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