Cerebral tuberculosis with dural sinus invasion

Case contributed by Dr Ian Bickle

Presentation

Cystic mass midline of occiput. Thought to be a sebaceous cyst. Patient dizzy. No fever.

Patient Data

Age: 20 years
Gender: Female

6cm mass in the central occipital area close to the vertex with a 1.8cm bony defect.

The external component is cystic but the larger intracranial element is composed of solid enhancing soft tissue. This is irregular and extends along the posterior interhemispheric fissure and invades the sagittal sinus.

2.7cm enhancing cystic lesion in the right occpital lobe.

Gross edema of the occipitoparietal regions bilaterally.

Comment: Large occiptal skull/dural based mass

The differential includes: haemangioperitocytoma, dural lymphoma, malignant meningoma and far less likely TB.

CT

Immediate recall for contrast study

See combined report above for CT head.

MRI BRAIN - with contrast and MRV

4cm midline occipital cystic lesion which communicates through a smooth defect of 9mm in the occipital bone. This directly communicates with thick irregular enhancing soft tissue surrounding and involving the posterior aspect of the sagittal sinus.

Several small sub-centrimetre nodules along the course of the sagittal sinus. No flow in the mid and posterior aspects of the sagittal sinus.

2.4cm rim enhancing cystic right occipital lobe lesion with avid internal restriction.

Intense, near symmetrical vasogenic edema in both parieto-occipital regions.

No hydrocephalus.

Infratentorial brain normal in appearance.

Comment:

1. Right occipital lobe cerebral abscess

2. Dural centered solid-cystic lesions - these appear most likely infectious-inflammatory in nature.

TB would be the first consideration.

3. Sagittal sinus occulsion with resultant cerebral edema

Case Discussion

This one was a puzzler for a start.  Especially the manner in which it presented to the CT department.

The patient was apyrexic and the presentation rather occult making CNS infection less down on the differential.  Having said this, TB if renown for not necessarily presenting without a pyrexia.

TB - the great mimicker.

PlayAdd to Share

Case information

rID: 60353
Published: 29th May 2018
Last edited: 31st May 2018
Tag: ripas2
Inclusion in quiz mode: Included

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.