Presentation
Headaches, low-grade fever, malaise with altered mental status in a patient treated for chest infection.
Patient Data
There are two lesions in the posterior cranial fossa, located in the right aspect of the brainstem and posteromedial aspect of the left cerebellar hemisphere. They demonstrate an iso-to low signal to the cortical grey matter on T1, T2 an FLAIR with extensive perilesional vasogenic edema mainly of the largest lesion, compressing and displacing the 4th ventricle. The postcontrast sequences demonstrate a ring-like enhancement of both lesions.
Another billobulated ring-like enhancing lesion is noted in the left posterior temporal region with surrounding vasogenic edema.
Dilatation of the 3rd and lateral ventricles (obstructive hydrocephalus) with no significant transependymal edema.
Case Discussion
The MRI features in a patient treated for chest infection (pulmonary tuberculosis in this case) are most consistent with cerebral tuberculomas (tuberculous granulomas).
In this case, the CSF analysis with culture was positive for tuberculous bacilli.