Presentation
Patient under treatment for chest infection for two months developed seizures with progressive deterioration of the level of consciousness.
Patient Data
The MRI sequences demonstrate innumerable small intra-axial nodules at both infra- and supratentorial levels as well as brainstem and basal ganglia, ranging from 3 to 7 mm in diameter. They appear of intermediate to low signal on T1WI, high signal on T2WI, and FLAIR with low signal centrally, and surrounding edema. The postcontrast sequences show ring-like and nodular enhancement. Moderate dilatation of the ventricular system (3rd and lateral ventricles) with mild enlargement of the cerebral sulci.
Note a low position of the cerebellar tonsils indicating a Chiari I malformation (incidental finding).
Right otomastoiditis is also noted.
Significant improvement with decreased in size and number of the infra- and supratentorial lesions.
Case Discussion
Case of miliary cerebral tuberculosis most likely the result of the spread of primary pulmonary tuberculosis (miliary pulmonary tuberculosis proven in this case).
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