Tuberculous Meningitis Joseph Junewick, MD FACR
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1 Tuberculous Meningitis Joseph Junewick, MD FACR 08/11/2010 History 14 month old with fever and increasing lethargy. Diagnosis Tuberculous Meningitis Additional Clinical Grandmother with active tuberculosis. Discussion Tuberculosis can affect virtually any organ system in the body and can be devastating if left untreated. Most tuberculous infections of the central nervous system are a result of hematogenous spread. Intracranial tuberculosis results in two related pathologic processes: tuberculous meningitis and intracranial tuberculomas. Tuberculous meningitis is a more frequent manifestation of neurotuberculosis than is brain tuberculoma and is more commonly seen in children. Meningeal involvement manifests as homogeneous enhancement most pronounced in the basal cisterns. There may be involvement of the meninges within the sulci over the cerebral convexities and in the sylvian fissures. Abnormal enhancement of the choroid plexus and ependymal lining of the ventricular system may rarely be seen. Sequelae of tuberculous meningitis include focal areas of atrophy secondary to infarcts and hydrocephalus and, rarely, syringomyelia or syringobulbia. The differential diagnosis for tuberculous meningitis includes other infectious agents (nontuberculous bacteria, viruses, fungi, parasites), noninfectious inflammatory disease affecting the leptomeninges (rheumatoid disease, sarcoidosis), and primary or secondary neoplastic involvement of meningeal surfaces (meningiomatosis, neoplastic meningitis from a peripheral tumor source, cerebrospinal fluid seeding from a primary tumor of the central nervous system). Findings CT-Basal leptomeningeal enhancement with mild ventriculomegaly. MR-Basal leptomeningeal enhancement with mild ventriculomegaly. Reference Andronikou S, Wilmshurst J, Hatherill M, VanToorn R. Distribution of brain infarction in children with tuberculous meningitis and correlation with outcome score at 6 months. Pediatr Radiol (2006); 36: Harisinghani MG, McCloud TC, Shepard JO, Ko JP et al. Tuberculosis from Head to Toe. Radiographics (2000); 20:
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