Presentation
Headache, vomiting and quadriparesis.
Patient Data
Left suboccipital craniotomy is seen with V.P. shunt is seen in situ. Multiple conglomerates and discrete ring-enhancing lesions, with T2 hypointense centers are seen in perimesencephalic, suprasellar, perimedullary, quadrigeminal interpeduncular, right Sylvian, pre and parapontine cisterns.
Meningeal enhancement is seen along the surface of the brainstem and along bilateral tentorium cerebelli. Small chronic infarcts are seen in the right thalamus. Lacunar infarcts and areas of ischemic demyelination seen in bilateral frontoparietal subcortical white matter and left lentiform nucleus. Mild prominence of bilateral lateral ventricles are seen (L>R).
Intradural extramedullary peripheral ring-enhancing lesion, appearing hypointense on T2 is seen at C2 level causing moderate compression of the cord. Long segment syringohydromyelia is seen throughout the cervicodorsal cord measuring up to 10 mm in maximum thickness. Extramedullary peripheral ring-enhancing lesion, appearing hypointense on T2 is seen at L4-5 level on the left side. Clumping of cauda equina roots is seen at right posterolateral aspect at L5-S1 level with enhancement on the postcontrast study. Diffuse spinal meningeal enhancement is seen.
Case Discussion
The patient is a follow-up case of tuberculous meningitis, on antitubercular treatment. Overall, findings are suggestive of cerebrospinal tuberculosis.
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