Type:
Educational Exhibit
Keywords:
Neuroradiology brain, Neuroradiology peripheral nerve, Neuroradiology spine
Authors:
M. D. Agrawal, P. S. Naphade, S. S. Sankhe, K. M. Siva; Mumbai/IN
DOI:
10.1594/ecr2010/C-2727
Background
CNS tuberculosis leads to significant neurological disability, complications, sequelae and mortality in developing countries. Its incidence has risen in tandem with the spread of HIV/AIDS. Clinicians depend upon neuroradiologist to provide accurate diagnosis and direct therapy.
Tuberculosis (TB), caused by Mycobacterium tuberculosis, accounts for eight million annual, worldwide deaths. Involvement of the central nervous system (CNS) is one of the most serious forms of this infection .Granulomatous inflammatory reaction in CNS caused by M. tuberculosis may involve the meninges, brain, spinal cord, and the bones covering the brain and spinal cord, and may manifest clinically depending on the specific location of the disease process.
Adult TB is most often a post primary infection, whereas most cases in childerns are due to primary infection. CNS tubercuosis may take a variety of forms, including tuberculous meningitis , abscess, focal cerebritis, tuberculoma and vasculitis leading to parenchymal infarcts. The most common radiographic findings associated with CNS TB include:
- Enhancement of the basal cisterns exhudates secondary to TBM
- Ring or disc enhancing granulomas usually multiple and supratentorial
- Focal cerebritis
- Calcified granuloma
- Hydrocephalous,usually communicating and occasionally obstructive due to entrapment of ventricle by granulomatous ependymitis.
- Leptomeningitis due to rupture of subependymal or subpial granulomata into the CSF
The atypical presentation of CNS tuberculosis are not uncommon. In this exhibit we present the key imaging features for early diagnosis of atypical cases of CNS tuberculosis, its complication with differential imaging features of ring enhancing lesions, its temporal evolution and its clinicopathologic correlation.