Cerebral tuberculomas

Case contributed by Dr Ammar Haouimi

Presentation

Patient treated for three weeks for a chest infection, presented with four days of repeated convulsions.

Patient Data

Age: 50 years
Gender: Female
MRI

MRI Brain

The MRI sequences demonstrate multiple intra-axial supratentorial lesions, one on, the right of frontal precentral location, and at least five on the left, the largest of temporal posterior location. These lesions are of low signal on T1WI, complex signal on T2WI with areas of low/high signal, surrounding vasogenic edema, and restricted diffusion on DWI. On postcontrast sequences, there is a peripheral ring enhancement of the small lesions and a cluster of ring enhancement of the largest lesion (granulomas). A mass effect is noted on the midline structures with subfalcine herniation.

The MRS (not shown) shows decreased NAA, and increased lipid/lactate.

Case Discussion

The MRI and MRS features in a patient treated for a chest infection (pulmonary tuberculosis in this case) are suggestive of intracranial tuberculous granulomas.

The patient's condition gradually improved with anti-tuberculous therapy.

 

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Case information

rID: 67627
Published: 17th Apr 2019
Last edited: 19th Apr 2019
Inclusion in quiz mode: Included
Institution: Aurès Medical Imaging Center - Batna Algeria

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