Tubercular meningitis with tuberculomas
Fever, altered sensorium, seizures for a period of 6 weeks.
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Multiple ring enhancing lesions as described, along with basal enhancing exudates.
MRI of the brain of an 11 year old female who presented with fever, altered sensorium and seizures over a six week period, reveals marked leptomeningeal enhancement, shaggy tentorial enhancement, enhancing basal exudates and multiple conglomerate ring enhancing lesions predominantly in basal cisterns. Obstructive hydrocephalus is also noted, with a right sided parietal VP shunt in situ.
CSF study reveals pleocytosis, decreased sugar level and increased protein.