Diffuse meningeal tuberculosis: case report (original) (raw)

Diffuse Meningeal Tuberculosis

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA

A central nervous system infection by Mycobacterium tuberculosis (MT), uncommonly seen in immunocompetent patients, brings a diagnose challenge in the modern medicine. Subdural space involvement of MT may simulate neoplastic or inflammatory diseases, bringing a direct influence in the therapeutics. We present a case report of a tetraparetic middleage woman with an atypical subdural space involvement by MT. Biopsy was done and the standard treatment for central nervous system MT was instituted, with a significant improvement in the motor function. In countries where MTinfection has high prevalence and incidence, an atypical intracranial mass should be always suspected for central nervous system involvement by MT.

The Diagnostic Parameters in Brain Tuberculosis Meningeal and Parenchymal

British Biomedical Bulletin, 2014

The aim of this study was to study the diagnostic parameters in brain tuberculosis (meningeal and parenchymal) Material and Methods: This study was conducted in the department of Neurosurgery and Neurology SKIMS for a period of two years. A total of 61 patients presenting with brain tuberculosis admitted at skims during these two years were included in the study. Results: The most presenting symptom in our study was headache found in 95.10% followed by vomiting found in 86.90% of subjects, fever in 78.70%, altered sensorium in 49.20%, seizures in 19.70% and diplopia in18%. Out of 61 patients cranial nerve involment was found in 34(55.73%) with 11 having more than two cranial nerves involved. The most common cranial nerve involved were 3rd and 6th. ADA was positive in 36 of 53 patients of TBM with a sensitivity of 67.9% and a specificity of 75%. PCR proved to be highly specific CT scan of head was abnormal in 56 out of 61 patients (91.8%). 12 (19.70%) were in stage I (meningeal involvement only), 29 (47.50%) were in stage II (parenchymal involvement only) and 15 (24.60%) were in stage III (both parenchymal and meningeal invlolvement). The most common finding in CT head was meningeal enhancement in 43 patients, hydrocephalus in 37 patients and tuberculomas in 14 patients. The most common sites of tuberculomas were frontal lobe (n=6; 42.8%), parietal lobe (n=4; 28.5%), followed by cerebellum in 2 patients and occipital in two. Nine patients had single and five multiple tuberculomas. Of the 14 patients with tuberculomas, hydrocephalus on CT was seen in 6 patients. Conclusion: CT scan is a useful diagnostic tool even in very early stages of TBM. Abnormalities reported on CT scan done are hydrocephalus, infarcts, basal enhancement, and tuberculomas. Normal study is reported in up to 20% of the cases.

Anatomical aspects of Mycobacterium tuberculosis – 1 associated destructive cranial lesions 2 3

2019

The authors report two cases of destructive cranial lesions associated with Mycobacterium tuberculosis-HIV coinfection in a male and female cadaver. Both cadavers were of African origin, from the Western Cape, South Africa. The authors present grossly abnormal tuberculosis-associated lesions of the anterior and middle cranial fossae, involving the ethmoid and sphenoid bones. Both individuals presented with tubercular intrasellar masses and obliteration of the paranasal sinuses. Current literature on cases such as these are extremely rare and others typically focus on lesions of the calvarium. Here we report on the gross anatomical findings as well as the relevant anatomical 2 aspects of the probable aetiology. Both cases presented here hold interest for medical professionals in Africa and other geographic regions. It further illustrates the importance of understanding the venous drainage of the paranasal sinuses when considering the manifestation and treatment of extrapulmonary TB.

Tuberculosis of the central nervous system: overview of neuroradiological findings

European Radiology, 2003

This article presents the range of manifestations of tuberculosis (TB) of the craniospinal axis. Central nervous system (CNS) infection with Mycobacterium tuberculosis occurs either in a diffuse form as basal exudative leptomeningitis or in a localized form as tuberculoma, abscess, or cerebritis. In addition to an extensive review of computed tomography and magnetic resonance features, the pathogenesis and the relevant clinical setting are discussed. Modern imaging is a cornerstone in the early diagnosis of CNS tuberculosis and may prevent unnecessary morbidity and mortality. Contrast-enhanced MR imaging is generally considered as the modality of choice in the detection and assessment of CNS tuberculosis.

Intracranial and Spinal Tuberculosis: A Rare Entity

Cureus, 2021

CNS tuberculosis has a broad spectrum of disease patterns and a high risk of complications and mortality. We present a case of a 36-year-old man who was diagnosed with neurotuberculosis with intracranial and spinal tuberculomas, meningitis, and spondylodiscitis. The patient was a known case of sarcoidosis and was being managed on corticosteroids. His presenting complaints were headache, low-grade fever, severe backache, lower limb weakness, and one episode of altered sensorium. The initial diagnosis was based on imaging findings, which were confirmed with positive cerebrospinal fluid (CSF) culture for Mycobacterium tuberculosis. Imaging and clinicopathological correlation enables early diagnosis and treatment and prevents permanent neurological sequelae.

Mr Findings Of Intracranial Tuberculosis Of Three Cases At Different Stages And Localization

Marmara Medical Journal, 2011

Merkezi sinir sistemi (MSS) tüberkülozu dünyanın belli bölgelerinde yaygın bir endemik sorun olmaya devam eden bulaşıcı bir hastalıktır. Intrakranial tüberküloma genellikle meningeal irritasyon ve artmış intrakranial basınç semptomları ile ortaya çıkan granülomatöz yer kaplayan kitle lezyonudur. Biz farklı aşamalarında ve lokalizasyonlarda intrakraniyal tüberkülozu olan üç olgunun manyetik rezonans görüntüleme (MRG) bulgularını bildirdik. Tüberkülozun MSS tutulumu tüberküloz menenjit ve tüberküloma şeklinde görülür. Tüberküloma formu daha sık görülür. Vücudun başka yerinde tüberkülozu olan ya da tüberkülozun endemik olduğu bölgede yaşayan hastaların MRG sinde halkasal şekilde kontrast tutan düşük sinyal intensiteli lezyon ya da T2 ağırlıklı sekanslarda geçici hiperintens sinyallerin görülmesi halinde ayırıcı tanıda MSS tüberkülozu düşünülmelidir.

Tuberculosis of the skull. A case report and review of the literature

Neurosurgical Review, 2000

A case of tuberculosis of frontal, ethmoid, and sphenoid bones with intracranial extension is presented. The patient had presented with a history of painless left frontal swelling for the previous 7 months. A diagnosis of tubercular etiology was established with the histopathology of the biopsy specimen. The patient was kept on antitubercular treatment for 18 months. She responded well, with a marked resolution of symptoms and radiologic findings. At the end of treatment, there was no clinical or radiological evidence of disease. At 6-month and 1-year follow-ups, there was no evidence of recurrence or reactivation of the disease.

Intracranial tuberculomas developing while on therapy for pulmonary tuberculosis

Lancet Infectious Diseases, 2005

A 22-year-old south Asian man was admitted with a 1-day history of altered mental status. He came to the USA 11 months before admission to attend graduate school. 4 months before admission, he presented with a chronic cough and cavitary lesions on chest roentgenogram. Sputum cultures grew Mycobacterium tuberculosis, which was sensitive to all first-line antituberculous agents. He received 2 months of induction chemotherapy with daily rifampicin, isoniazid, pyrazinamide, and ethambutol, followed by twice-weekly maintenance therapy with isoniazid and rifampicin. All medications were administered under directly observed therapy. He was compliant with the regimen and quickly returned to his usual activities.

Tuberculosis of the skull mimicking a bony tumor

Asian journal of neurosurgery

We present a rare case of calvarial tuberculosis mimicking a solitary bone tumor, which was surgically removed. A 52-year-old female presented with a right forehead swelling, which gradually enlarged over the course of 2 years, with no symptoms or raised intracranial pressure or neurological deficits. Plain and contrast-enhanced brain computed tomography scans were done, revealing a punched-out lesion of the right frontal bone, with a nonenhancing lytic mass. With an initial diagnosis of an intraosseous meningioma, and later on intraoperatively thought to be a metastatic tumor, the mass was excised along with a rim of bone. Histopathological examination results came back as caseous necrosis, highly suggestive of tuberculosis. The patient was then treated with a 1 year regimen of anti-tuberculous medications. Tuberculosis of the cranium is a rare entity, and can mimic tumors or multiple myeloma. A high index of suspicion and knowledge is required for an early diagnosis. A combined su...