TB meningitis with ring-enhancing parenchymal lesions (tuberculomas).
Multiple focal T2 and FLAIR hypointense lesions in the right occipital, bilateral parietal para-sagittal and bilateral cerebellar regions with related variable degrees of vasogenic edema. The related vasogenic edema can be clearly demonstrated after CSF signal is attenuated. The lesions are iso to hypointense on T1. The related edema reflects hypointense signal. However, there is linear meningeal and gyriform T1 hyperintense signal in the right occipital region as well as scattered heterogeneous hyperintensities at the para-sagittal parietal regions.
Increased ADC values, confirming no diffusion restriction.
Intense post contrast peripheral ring enhancement of the previously described lesions (tuberculomas) together with evident thickened enhancing meninges at the right occipital cortex, right tentorial leaflet and posterior aspect of the falx. Multiple signal void areas are appreciated coinciding with the hyperintensities demonstrated on non-enhanced T1, confirming the hemorrhagic nature of this signal. Meningeal involvement is clearly demonstrated. Some of the lesions (tuberculomas) are also seen to be dural-based. Involvement of the corpus callosum is also noted.