Miliary intracranial tuberculomas with tuberculous meningitis

Case contributed by Paresh K Desai
Diagnosis almost certain

Presentation

Miliary tuberculosis of the lung on four antitubercular drug therapy. Headache, neck stiffness. MRI is done after an equivocal CT brain.

Patient Data

Age: 35 years
Gender: Male

CSF analysis was with high proteins, lymphocyte predominant cerebrospinal fluid.

Adenosine Deaminase of CSF>30units

Focal meningeal thickening in the suprasellar cistern, along the clivus with multiple miliary granulomas.

Chronic infarct in the right basal ganglia region and in the left cerebellar peduncles

Case Discussion

Miliary granulomas are rare presentations of CNS tuberculosis.

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