Tuberculous MeningitisJoseph Junewick, MD FACR

08/11/2010

History14 month old with fever and increasing lethargy.

DiagnosisTuberculous Meningitis

Additional ClinicalGrandmother with active tuberculosis.

DiscussionTuberculosis 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 andintracranial tuberculomas. Tuberculous meningitis is a more frequent manifestation ofneurotuberculosis than is brain tuberculoma and is more commonly seen in children.Meningeal involvement manifests as homogeneous enhancement most pronounced in the basalcisterns. There may be involvement of the meninges within the sulci over the cerebral convexities andin the sylvian fissures. Abnormal enhancement of the choroid plexus and ependymal lining of theventricular system may rarely be seen. Sequelae of tuberculous meningitis include focal areas ofatrophy secondary to infarcts and hydrocephalus and, rarely, syringomyelia or syringobulbia.The differential diagnosis for tuberculous meningitis includes other infectious agents (nontuberculousbacteria, viruses, fungi, parasites), noninfectious inflammatory disease affecting the leptomeninges(rheumatoid disease, sarcoidosis), and primary or secondary neoplastic involvement of meningealsurfaces (meningiomatosis, neoplastic meningitis from a peripheral tumor source, cerebrospinal fluidseeding from a primary tumor of the central nervous system).

FindingsCT-Basal leptomeningeal enhancement with mild ventriculomegaly.MR-Basal leptomeningeal enhancement with mild ventriculomegaly.

ReferenceAndronikou S, Wilmshurst J, Hatherill M, VanToorn R. Distribution of brain infarction in children withtuberculous meningitis and correlation with outcome score at 6 months. Pediatr Radiol (2006);36:1289-1294.Harisinghani MG, McCloud TC, Shepard JO, Ko JP et al. Tuberculosis from Head to Toe.Radiographics (2000); 20:449-470.

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