Cerebral tuberculosis

Case contributed by Dr Ian Bickle

Presentation

Patient admitted with reduced conscious level. No known history of TB.

Patient Data

Age: 50-55 years
Gender: Female
CT

Admission CT head was normal. Repeat CT after GCS drop shown.

Intense symmetrical nodular enhancement of the leptomeninges overlying the tentorium, with vivid illustration of the cerebellar folia.

No thickening or enhancement of the basal cisterns.

Moderate biventricular hydrocephalus with minor transependymal oedema.

MRI

Diffuse high signal change in the cerebellar vermis and anterioinferiorly in both cerebellar hemispheres.

Intense symmetrical nodular enhancement of the leptomeninges overlying the tentorium.

No thickening or enhancement of the basal cisterns.

Moderate biventricular hydrocephalus with minor transependymal oedema.

Case Discussion

Lumbar puncture was performed which was interpreted as being suggestive of possible TB, but negative for AFFB.

AFFB positive sputum.     Chest x-ray suggestive of prior TB.

Extensive investigation for a tumour was undertaken which was negative.

The patient was treated for TB.

Cerebral TB may manifest itself in a number of ways including cerebral leptomeningitis and cerebral abscess.

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Case information

rID: 54103
Case created: 22nd Jun 2017
Last edited: 22nd Aug 2017
Inclusion in quiz mode: Included

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