Neuroimaging Findings in Tuberculosis: A Single‐Center Experience in 559 Cases

Abstract

BACKGROUND AND PURPOSE There is a paucity of literature related to the neuroimaging of CNS tuberculosis (TB) and largely covers pediatric CNS TB. The objective of this study was to determine the frequency of different forms of CNS TB and its associated complications and to study longitudinal disease course using computed tomography (CT) and MRI. METHODS Retrospective chart and imaging review of patients diagnosed with CNS TB in a tertiary care hospital in Pakistan over a 10‐year period. A total of 452 initial brain MRI and 209 CT scans were reviewed by an expert radiologist specialized in neuroimaging. This was followed by review of 53 MRI/52 CT and 7 MRI/14 CT first and second follow‐up scans, respectively. RESULTS Note that 559 patients, 296 males and 263 females were included in the study. On the initial CT scans, tuberculomas were found in 25 (12%), infarction in 54 (25%), basal meningeal enhancement in 29 (14%), and hydrocephalus in 84 (40%). On initial MRI, tuberculomas were found in 182 (40%), infarction in 120 (27%), basal meningeal enhancement in 184 (41%), and hydrocephalus in 116 (26%). On review of follow‐up CT scans, 13 (25%) showed new or worsening hydrocephalus, 8 (15%) showed new infarcts, 1 exhibited new tuberculoma, and 5 showed worsening cerebral edema. On review of follow‐up MRI scans, new or worsening hydrocephalus was seen in 3 (6%), new infarcts in 3 (6%), new tuberculoma in 10 (19%), worsening cerebral edema in 7 (13%), and TB myelitis in 4 (8%) patients. CONCLUSIONS Tuberculoma, hydrocephalus, and cerebral infarcts are the most prominent findings in CNS tuberculosis. Our study showed development of new lesions on subsequent neuroimaging suggesting a dynamic and progressive nature of the disease process in some individuals.

Tuberculous Meningitis in an Immunocompetent Host: A Diagnostic Challenge

“…look for coexisting extraneural manifestations of tuberculosis is rewarded. MRI is superior to CT scan in sensitivity and specificity, and considered the modality of choice for radiological assessment of CNS tuberculosis [11]. The characteristic imaging findings of tuberculous meningitis include basal cisternal and leptomeningeal enhancement, hydrocephalus, periventricular infarcts, and tuberculomas.…”

Central nervous system and spinal cord tuberculosis: Revisiting an important disease

“…However, they are uncommon presentations and need a specific clinical correlation to consider TB as the cause of these infarctions. Specific sequences of MRI angiography and venography may help in the diagnosis [51].…”

Tuberkuloma Serebral Pada Penderita Acquired Immune Deficiency Syndrome

“…Pada dewasa, lokasi tuberkuloma lebih sering muncul di area supratentorial, sedangkan pada anak cenderung di daerah infratentorial. [8][9] Gejala tuberkuloma umumnya bervariasi, seperti nyeri kepala, kejang, paresis saraf kranialis, atau tanda klinis lainnya yang berhubungan dengan peningkatan tekanan intrakranial. Manifestasi klinis yang non spesifik ini hampir tidak bisa dibedakan dengan lesi space occupying lainnya, sehingga sangat esensial untuk mengevaluasi etiologi lain seperti malignansi, sarkoidosis, abses piogenik, atau toksoplasmosis.…”