Miliary tuberculosis involving the brain

Case contributed by Dr Ahmed Abd Rabou

Presentation

Headache and deterioration of the level of consciousness. No vomiting, upper or lower limb weakness

Patient Data

Age: 6 years old
Gender: Female
Modality: MRI

Innumerable small size (+/- 1 cm) focal lesions are seen scattered all over the brain involving the cerebral hemispheres, brainstem and cerebellum. The lesions are isointense on T1 and have low intensity center on T2/FLAIR with peripheral hyperintensity and surrounding edema. No significant mass effect. They show marked ring enhancement after contrast administration.

Modality: MRI

This study was done 4 months later under umberella of TB therapy. There is almost near total resolution of the scattered focal lesions however the patient developed basal meningitis as shown by thickened enhancing meningeal lining at the suprasellar cistern and clivus with associated communicating hydrocephalus. Moreover there is right basal ganglionic old infarction at MCA territory mostly from arteritis.

Case Discussion

After successful antituberculous therapy the clinical diagnosis of miliary TB of the brain was made. The patient was found immunosuppressed and tuberculin negative. Other focal lesions were found at the spleen and liver. There is increased incidence of arterial infarction in case of basal meningitis specially in children.

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Case Information

rID: 39776
Case created: 20th Sep 2015
Last edited: 1st Oct 2015
Inclusion in quiz mode: Included

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