Cerebral tuberculomas

Case contributed by A.Prof Frank Gaillard

Patient Data

Age: 30 years
Gender: Male
Modality: CT

Multiple enhancing lesions are demonstrated - some demonstrate peripheral enhancement whereas others demonstrate confluent enhancement. These are located within both parietal/occipital lobes, left frontal lobe, left temporal lobe, right posterior external capsule and left cerebellar hemisphere. There is prominent oedema surrounding most of the lesions.

Punctate calcific foci are noted within the right parietal lobe. No meningeal enhancement appreciated. No midline shift. No hydrocephalus. 

Modality: MRI

Numerous peripherally enhancing lesions are demonstrated measuring between 3mm and 8 mm in diameter, with many clustered together becoming confluent, particularly prominently in the right parietal and left occipitoparietal regions. These are located peripherally and are likely seated deep within sulci, extending into adjacent brain with associated oedema. This is most pronounced in the right parietal lobe (precuneus sucli), left occipitoparietal region (occipitoparietal sulcus), and to a lesser degree left frontal lobe (superior frontal sulcus). A few lesions are definitely intra axial, most notably involving the putamen on right. A few of these lesions demonstrate moderate restricted diffusion.No evidence of basal meningitis or pachymeningitis. Ventricles are unremarkable in size. MR angiography is unremarkable, with no narrowings or aneurysms in the portions visualised.

Conclusion: Numerous peripherally enhancing lesions appear predominantly centred on sulci and presumably represent small tuberculomas with associated cerebritis as a sequela of known prior tuberculous meningitis. 

Case Discussion

This patient has had the diagnosis of TB confirmed histologically and on microbiology in another country, with compelling documentation. 

 

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Case Information

rID: 37702
Case created: 19th Jun 2015
Last edited: 13th Oct 2016
Inclusion in quiz mode: Included

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