Presentation
Cough, chest pain, prolonged fever, headache
Patient Data
Diffuse 1–3 mm nodules in a random distribution in both lungs represent characteristic findings of miliary tuberculosis.
Several nodular lesions (tuberculomas) scattered in the brain vary with the stage of the disease
Some nodules show hypointensity on T1-weighted imaging, hyperintensity on T2-weighted imaging, no suppression on FLAIR, no restricted diffusion, and homogeneous enhancement. They represent non-caseating granulomas.
Some lesions centrally show low T2 signal in the center, ring enhancement, which represents caseating granulomas.
Otherwise, there is restricted diffusion in the right thalamus, indicating infarction.
Case Discussion
In this case, we can easily diagnose an intracranial tuberculous granuloma due to these typical findings on a young patient's chest CT.
In one study with a large sample of CNS tuberculosis patients, tuberculomas were present in 50% of patients, while infarcts were present in 25% 1. These infarcts most likely represent vasculitis involving small and medium vessel disease.
Besides that, with patients suspected of central nervous system tuberculosis, we have to investigate whether it involves tuberculosis meningitis, hydrocephalus, or pathological nerve conditions. Luckily, we don’t see any lesions like these in this case.
Unable to process the form. Check for errors and try again.