Cerebral tuberculosis

Case contributed by Dr Dalia Ibrahim

Presentation

Seizures and bilateral upper and lower limb weakness.

Patient Data

Age: 10 years
Gender: Female
MRI

Bilateral temporal cortical and subcortical as well as left deep basal ganglia (caudate head) multiple small confluent space-occupying lesions eliciting istointnese signal on T1 WI, low signal on T2 WI with necrotic center. They also show diffusion restriction and marginal post-contrast enhancement. The lesions are surrounded by vasogenic edema and exert mass effect.

MRS study revealed markedly elevated lipid/lactate peak denoting tissue necrosis. No significant elevation of the Choline peak.

Case Discussion

The patient tested positive for sputum acid-fast bacilli (AFP) and genexpert for TB. CSF analysis was positive for AFP, and his CT scan of the chest revealed post-primary active pulmonary TB.

The radiological criteria for this case were highly suggestive of cerebral TB especially the confluent small lesions, low T2 signal, diffusion restriction, and marginal post-contrast enhancement. The MRS criteria were also highly suggestive with markedly elevated Lipid/lactate peaks.

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