Tuberculous granulomas
Updates to Case Attributes
Lumbar puncture was performed. Mycobacterium tuberculosis was detected in the CSF analysis. PatientThe patient was started on ATT and patient condition improved.
Various forms of neruotuberculosisCNS tuberculosis can be detected on imaging evaluation, using MRI. The most common forms includes leptomeningitis, pachymeningitis, tuberculoma, cerebritis, abscess formation, and encephalitis. Each of these forms have their own appearanceappearances or may coexist and differential diagnoses on imaging. One of the differential diagnosis in this case would be neurocysticercosis, however leptomeningeal involvement is uncommon and usually involves the basal cisterns.
-<p>Lumbar puncture was performed.<em> Mycobacterium tuberculosis </em>was detected in the CSF analysis. Patient was started on ATT and patient condition improved.</p><p>Various forms of neruotuberculosis can be detected on imaging evaluation, using MRI. The most common forms includes leptomeningitis, pachymeningitis, tuberculoma, cerebritis, abscess formation, and encephalitis. Each of these forms have their own appearance and differential diagnoses on imaging. One of the differential diagnosis in this case would be neurocysticercosis, however leptomeningeal involvement is uncommon and usually involves the basal cisterns.</p>- +<p>Lumbar puncture was performed.<em> Mycobacterium tuberculosis </em>was detected in the CSF analysis. The patient was started on ATT and patient condition improved.</p><p>Various forms of CNS tuberculosis can be detected on imaging evaluation. The most common forms includes leptomeningitis, pachymeningitis, tuberculoma, cerebritis, abscess formation, and encephalitis. Each of these forms have their own appearances or may coexist and differential diagnoses on imaging. One of the differential diagnosis in this case would be neurocysticercosis, however leptomeningeal involvement is uncommon and usually involves the basal cisterns.</p>
References changed:
- 1. Yeaney G, Kolar B, Silberstein H, Wang H. Case 163: Solitary Neurocysticercosis. Radiology. 2010;257(2):581-5. <a href="https://doi.org/10.1148/radiol.10090856">doi:10.1148/radiol.10090856</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/20959550">Pubmed</a>
- 2. Khatri G, Krishnan V, Antil N, Saigal G. Magnetic Resonance Imaging Spectrum of Intracranial Tubercular Lesions: One Disease, Many Faces. Pol J Radiol. 2018;83:e524-35. <a href="https://doi.org/10.5114/pjr.2018.81408">doi:10.5114/pjr.2018.81408</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30800191">Pubmed</a>
- Yeaney G, Kolar B, Silberstein H, Wang H. Case 163: Solitary Neurocysticercosis. Radiology. 2010;257(2):581-585.
- Khatri GD, Krishnan V, Antil N, Saigal G. Magnetic resonance imaging spectrum of intracranial tubercular lesions: one disease, many faces. Pol J Radiol. 2018 Dec 29;83:e524-e535.
Updates to Study Attributes
MRI brain plain with contrast performed and revealed.
Ill-defined altered signal intensity lesions in bilateral frontal lobes, splenium of corpus callosum on left side, right globus pallidus and thalamus, midbrain on right side, left temporal lobe, bilateral occipital lobes and left cerebellar hemisphere. Post contrast study shows ring enhancement of the lesions in splenium of corpus callosum, midbrain and left cerebellar hemisphere. Rest of the lesions shows nodular homogenous enhancement.
Post contrast FLAIR shows enhancement along sulcal spaces of left frontotemporal lobe and right frontal lobe, sylvian fissure on left side.
A diagnosis of multiple tuberculomas with associated leptomeningitis was given.
Updates to Study Attributes
Screening of the whole spine revealed -
T2 hyperintensity with endplate irregularity involving inferior end plate of D12 and superior end plate of L1 vertebral bodies and intervening intervertebral disc, which was indicative of infective spondylodiscitis.