Tuberculous pachymeningitis

Last revised by Yahya Baba on 18 Dec 2021

Tuberculous pachymeningitis is a rare form of CNS tuberculosis characterized 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: hypointense thickened dura mater
  • T2: hypointense thickened meninges
  • T1 C+ (Gd): intense homogenous enhancement of thickened meninges

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

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