CASE 970 Published on 30.07.2001

Brain tuberculosis

Section

Neuroradiology

Case Type

Clinical Cases

Authors

A. Loshkajian, R.Sigal

Patient

25 years, male

Categories
No Area of Interest ; Imaging Technique CT
Clinical History
Fever and convulsions in an immunocompromized patient
Imaging Findings
A 25 year old patient followed up in our institution for an acute leukemia is admitted to the emergency department for fever and convulsions.Since the beginning of his chemotherapy treatment, his immunological status has been altered and he developped a pulmonary tuberculosis.
Discussion
The CT demonstrates multiple ring-enhancing lesions in the cerebellum, brain stem, frontal and temporal lobes. The surrounding perilesionnal edema is moderate without mass effect on the ventricular system. There is also a slight enhancement of the basilar meninges. There is no evidence of calcification nor brain hemorrhage. The diagnosis of brain tuberculosis was suspected in this clinical context and confirmed by bacteriological culture of CSF demonstrating mycobacterium tuberculosis. The diagnosis of tuberculoma was retained. Brain abscess is a rare complication of tuberculosis. It is defined as an encapsulated collection of pus called tuberculoma. It is characterized microscopically by lymphocytic infiltrate, Langerhan’s giant cells, epitheliod cells and variable evidence of scare tubercle bacilli. Tuberculomas are either solitary or multiple, situated in the cortical or subcortical regions. Most common sites are cerebral hemispheres and basal ganglia in adults and the cerebellum in children. Intraventricular localizations are rare. Macroscopically, they are classified into mature and immature forms. -the mature form consists of a well-defined avascular mass with central caseating necrosis, surrounded by granulation. -the immature form is represented by multiple small tuberculomas, some with caseating or cystic centers dispersed within edemtous brain. The incidence of brain tuberculosis has increased in the last decade because of the HIV pandemy, drug and alcohol abuse, homelessness and poor sanitation. The radiological aspects of brain tuberculosis are not specific and resemble those of brain abcess. CT and MRI demonstrate solitary or multiple nodular masses, often in the cortex or cortico-medullary junction with variable edema. A ring enhancement is also demonstrated after contrast administration. Some other radiological signs of tuberculous infection are cisternal enhancement, basilar meningitis, cisternal enhancement and communicating hydrocephalus. The diagnosis is confirmed by bacteriological culture of the CSF. The main differential diagnosis in this context are all other pyogenic infections and abscesses.
Differential Diagnosis List
Central nervous system tuberculosis
Final Diagnosis
Central nervous system tuberculosis
Case information
URL: https://www.eurorad.org/case/970
DOI: 10.1594/EURORAD/CASE.970
ISSN: 1563-4086