Headache. Drowsiness. Post EVD insertion for hydrocephalus on CT brain.
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Enhancement and high FLAIR signal in the basal cisterns (best seen at the level of the midbrain and pons) is classical for tuberculous meningitis. Ventricular dilatation is stable and compatible with communicating hydrocephalus secondary to tuberculous meningitis. High FLAIR signal at the vertex is non-specific and can be seen in the setting of meningitis or hyperoxygenation.
This patient presented with fevers and drowsiness. Initial CT brain demonstrated marked hydrocephalus and the patient was taken for urgent ventricular decompression. Subsequent CSF testing demonstrated tuberculosis meningitis.
Mycobacterial investigation specimen
Specimen Type: CSF
- Auramine-Rhodamine Stain: 1-9 Acid Fast Bacilli DETECTED per 100 HPF
- Ziehl-Neelsen Stain: 1-9 Acid Fast Bacilli DETECTED per 100 HPF
NUCLEIC ACID TESTING (ON SPECIMEN) M. tuberculosis Complex PCR: DETECTED