Tuberculous meningitis: cerebral tuberculomas and spinal cord involvement
Citation, DOI, disclosures and case data
At the time the case was submitted for publication Ammar Haouimi had no recorded disclosures.View Ammar Haouimi's current disclosures
Six weeks history of low-grade fever, headaches, and malaise with altered mental status, and paraparesis one week before the MRI exam.
The MRI sequences demonstrate intense and extensive thickening with nodular enhancement of the basal subarachnoid cisterns, along the middle cerebral arteries to the Sylvian fissures. Mild dilatation of the 3rd and lateral ventricles suggesting associated obstructive hydrocephalus.
Diffuse leptomeningeal enhancement is seen as nodular and linear enhancement along the cerebellar surface as well as at the cerebral hemispheres with small tuberculomas at the left Sylvian regions. A small left corona radiata area of high signal on FLAIR and T2WI most likely a focal established infarct (no restricted diffusion).
Extensive linear and nodular thickening with enhancement along the entire spinal cord up to the cauda equina.
A lumbar puncture was performed with CSF analysis showing: pleocytosis, elevated protein levels, low glucose level, and increased WBC count.
Additional contributor: A. Ramdani, MD