Presentation
Patient with HIV, 3C stage. Pulmonary TB, fever, headache, and altered mental status.
Patient Data
MRI shows a significant leptomeningeal enhancement predominantly in basal cisterns, with enhancement of the 3rd, 5th, 6th, 7th and 8th cranial nerves.
On the FLAIR sequence, there is an alteration in signal intensity at the right temporal lobe and right middle cerebellar peduncle.
Basal ganglia show areas with diffusion restriction that do not enhance after administration of paramagnetic contrast.
Cerebellar nodular lesions (tuberculomas) are identified that demonstrate enhancement.
Case Discussion
Mycobacterium tuberculosis was isolated from the CSF fluid in this patient.
Imaging features show the typical findings of tuberculous meningitis such as leptomeningeal and basal enhancement, arteritis, and tuberculomas. Tuberculous leptomeningitis is the most common presentation of CNS tuberculosis.