Tuberculous pachymeningitis is a rare form of CNS tuberculosis characterised by a chronic tuberculous infection leading to a dura mater involvement. Common sites of involvement are cavernous sinuses, floor of middle cranial fossa and tentorium.
This condition should not be confused with the common tuberculous leptomeningitis, which is discussed separately.
The epidemiology of patients with tuberculomas is the same as that of other CNS manifestations of TB (see CNS tuberculosis)
- hyperattenuating solid plaque like densities (calcification may be seen)
- T1: hypo intense thickened dura mater
- T2: hypo intense thickened meninges
- T1 C+ (Gd): intense homogenous enhancement of thickened meninges
Treatment and prognosis
Treatment of CNS tuberculosis is based on an anti-tubercular treatment regimen. However, multi-drug resistant tuberculosis remains a major hurdle in treatment.
General imaging differential considerations include
- causative agent
- pulmonary tuberculosis
- cardiac tuberculosis
- CNS tuberculosis
- tuberculous otomastoiditis
- gastrointestinal tuberculosis
- genitourinary tuberculosis
- renal tuberculosis
- skeletal tuberculosis
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