Presentation
Headaches, low-grade fever with deterioration of the level of consciousness in a patient treated for chest infection for 1 month. A brain CT (not shown) demonstrates numerous small calcifications in the cerebellum and cerebral hemispheres.
Patient Data
Innumerable small intra-axial nodules scattered over the cerebellum, brainstem and cerebral hemispheres. These nodules demonstrate a high signal on T1 and FLAIR and iso-to slight high signal on T2 with nodular and ring-like enhancement on post-contrast sequences. No significant surrounding edema.
Associated pachymeningeal thickening with enhancement more on the left.
Calvarial thickening at the left occipitoparietal region could be due to focal osteitis.
Case Discussion
MRI features of innumerable enhancing nodules scattered over the cerebellum, brainstem and cerebral hemispheres suggestive of miliary tuberculosis with tuberculous pachymeningitis (most likely the result of spread) in a patient treated for primary pulmonary tuberculosis since 1 month (proven in this case). The calvarial thickening could be due to focal tuberculous osteitis.
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