Learning objectives
Identify the clinical and radiologic findings in tuberculosis affecting the central nervous system.
Describe the differential diagnosis and appropriate imaging work-up for this infectious process.
Background
We report a retrospective study that evaluates 40 cases of tuberculosis involving the central nervous system seen during three year- period from January 2009 to December 2011.
Patients were admitted with variant clinical features: headache,
fever,
vomiting,
neck stiffness,
anorexia/weight loss,
confusion,
neurological deficit,
seizures.
Fig.
1
All the patients were evaluated with CT scan or MRI or both.
All diagnoses were confirmed by biological and/or histopathological analysis .
Imaging findings OR Procedure details
The results that were obtained: Fig.
2
Meningitis (n=12),
encephalitis (n=3),
tuberculoma(n=8),
tuberculous brain abscess (n=3),
tuberculous vasculitis (n=2),
myelitis (n=4),
spinal tuberculosis (n=7),
calvarial tuberculosis(n=1).
MENINGEAL TUBERCULOSIS
Tuberculous meningitis (TBM) is the most common presentation of neurotuberculosis and occurs predominantly in young children and adolescents.
Clinical features
TBM most often presents with fever,
headache,
decreased level of consciousness,
and meningeal signs such as neck stiffness,
photophobia,
and vomiting.
In addition,
symptoms related to cranial nerve involvement and focal ischemic syndromes may occur.
Radiological patterns...
Conclusion
The clinical and radiologic patterns of tuberculosis may mimic those of many other diseases.
It is imperative that radiologists and clinicians understand the spectrum of imaging features of central nervous system tuberculosis to aid in making an early diagnosis.
References
1) A.
Bernaerts et al.
Tuberculosis of the central nervous system: overview of neuroradiological findings.
EurRadiol (2003) 13:1876–1890.
2) SrikanthMoorthy.Nirmal K.
Prabhu.Spectrum of MR Imaging Findings in Spinal Tuberculosis .AJR October 2002 vol.
179 no.
4 979-983.
3) G.Luthra et al.
Comparative Evaluation of Fungal,
Tubercular,
andPyogenic Brain Abscesses with Conventional andDiffusion MR Imaging and Proton MRSpectroscopy.
AJNR Am J NeuroradiolAug (2007) 28:1332–38.
4) AG.
OSBORN et al.
Diagnostic imaging brain.
1ST ED.Salt lake city.
Amirsys.
2004
5) Parmar H,
Sitoh YY,
Anand P,
Chua...