MRI - MRI brain with contrast
Axial T2
Sagittal FLAIR
Sagittal T1
Sagittal T1 C+
Axial DWI
Axial ADC
Findings: There are multiple small ring enhancing lesions demonstrated predominantly in the posterior fossa, with at least eight lesions demonstrated in the cerebellum, two lesions in the pons and one lesion left inferomedial temporal lobe. In addition, there are multiple areas of subcortical enhancement throughout both cerebral hemispheres. None of these lesions show restricted diffusion.
There are large lesions which are not-enhancing, hypointense on T1 and hyperintense on T2/FLAIR, which show restricted diffusion in both corona radiata and the posterior limb of the left internal capsule.
Incidental empty sella.
In view of positive AAFB (acid alcohol fast bacilli) on lumbar puncture: Multiple tuberculomas in the posterior fossa, brainstem and inferomedial left temporal lobe. Evidence of subcortical enhancement elsewhere. Restricted diffusion demonstrated in the deep white matter bilaterally in keeping with ischaemia secondary to TB arteritis.