Learning objectives
To familiar with epidemiology and pathophysiology of CNS tuberculosis.
To discuss the imaging spectrum of CNS tuberculosis (TB meningitis and parenchymal TB) on CT and MRI.
To know the complications of CNS tuberculosis.
Background
Tuberculosis (TB),
caused by Mycobacterium tuberculosis,
accounts for eight million deaths worldwide annually.
Tuberculous involvement of the central nervous system (CNS) is an important and serious type of extra-pulmonary involvement.
Approximately 10% of all patients with tuberculosis have CNS involvement.
However,
its prevalence is greater in immunocompromised patients and is seen in upto 15% of cases of acquired immunodeficiency syndrome-related TB.
CNS TB usually results from haematogenous spread (Fig.1,2).
However,
it may result from direct rupture or extension of a sub-pial (beneath the piamater) or...
Findings and procedure details
Spectrum of lesions in CNS TB,
Meningeal:
TB meningitis
Miliary and leptomeningeal granuloma
Parenchymal:
Tuberculous granuloma (tuberculoma)
Tuberculous abscess
Tuberculous encephalopathy
Tuberculous cerebritis
Non-osseous spinal cord tuberculosis
Complications:
Vasculitis and infarction
Cranial neuropathy
Calvarial tuberculosis,
subdural and epidural abscess.
Immune Reconstruction Inflammatory Syndrome(IRIS).
TB meningitis (TBM):
TB meningitis is the most common manifestation of CNS.
It may result from either haematogenous spread or rupture of Rich focus.
Generally,
pre-contrast MR imaging cannot detect pathological,
signal from meningeal inflammation or basal exudates in early stages.
However,...
Conclusion
CNS TB is a major cause of morbidity and mortality in patients with tuberculosis.
MR imaging plays a crucial role in diagnosis because of its inherent sensitivity and specificity in detecting CNS lesions earlier than CT.
We conclude that conventional MRI imaging supplemented by advanced MRI techniques helps in improved detection and characterisation of CNS tuberculosis and may help in better management of these patients.
References
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Tandon PN,
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Tuberculosis of the central nervous system.
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Spillane JD),
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p.
37-62.
2.
Wood M,
Anderson M.
Chronic meningitis.
Neurological infections; major
problems in Neurology,
vol 16. 1998 (WB Saunders,
Philadelphia),
pp 169-
248.
3.
Whiteman ML.
Neuroimaging of central nervous system tuberculosis in
HIV-infected patients.
Neuroimaging Clin N Am 1997; 7(2): 199-214.
4.
Morgado C,
Ruivo N.
Imaging meningo-encephalic tuberculosis.
Eur J
Radiol 2005; 55(2): 188-92.
5.
De Castro CC,
de Barros...