Keywords:
Neuroradiology brain, Neuroradiology peripheral nerve, Neuroradiology spine
Authors:
D. Kumar, R. Sheoran, S. K. Bansal, O. P. Arora; Ludhiana/IN
DOI:
10.1594/ecr2010/C-2760
Methods and Materials
Material and methods
This retrospective study includes 21 patients of either surgically or clinically (mainly response to ATT) proven CNS tuberculosis. These patients presented with varied clinical features such as fever, headache, nausea, vomiting, photophobia, cranial nerve palsies, limb weakness and altered sensorium with signs & symptoms localized to the topographic location of tuberculomas. There were 13 male and 8 female patients with age range between 9 to 70 years (Mean age- 30years). Imaging was performed either with MDCT, MRI or both. Routine pulse sequences were obtained. Only five patients had active tubercular focus elsewhere in the body. None of the patients was immunocompromised. Three patients underwent surgery, whereas in rest of the patients the diagnosis was confirmed with response to ATT.
Qualitative analysis:
Morphological features of solid enhancing, ring enhancing and giant tuberculoma were described in T1W and T2W images on the basis of signal intensity. Presence of more than one lesion was considered as ‘multiple’ and solid enhancing lesion of more than one cm. size was considered as ‘giant tuberculoma’. Irregularly marginated enhancing projection from the outer wall of ring enhancing and/or solid lesions was described as ‘outer rim excrescence sign’. Other classical findings of CNS tuberculosis like multiplicity of lesions, enhancing exudates, leptomeningeal enhancement, focal cerebritis and infarct were taken into consideration for making the diagnosis.
Pathophysiology:
There is hematogenous spread of tubercle bacilli to CNS which may be primary or more commonly secondary to infection elsewhere in the body. Rupture of Rich focus (focus of infection) in subpial or subependymal region gives rise to generalized bacillimia in subarchnoid space and CSF. Meningitis is the most frequent manifestation of CNS tuberculosis; however incidence of other manifestations keeps on increasing which includes tubercular granuloma, abscess, cerebritis, pachymeningitis, spondylodiscitis and spinal arachnoiditis.