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Tuberculous meningitis

Case contributed by Vinay Shah
Diagnosis almost certain

Presentation

Seizures with altered consciousness.

Patient Data

Age: 14 months
Gender: Male
mri

Altered signal areas are seen in the bilateral fronto-parietal and perisylvian cortical-subcortical region, which shows subtle restricted diffusion seen on DWI. After administration of contrast, there is gyriform enhancement seen in the bilateral fronto-parietal, perisylvian region and left temporal region.

Multiple small subcentimeter size nodular and ring enhancing lesions are seen in both cerebellum, midbrain and bilateral parieto-occipital region.  

There is an exaggerated enhancement of the meninges seen at basal cistern and along the cortical sulci.

Mild dilatation of both the lateral and third ventricles.

Case Discussion

These findings represent changes of meningitis with small tuberculomas and cerebritis / subacute infarcts. 

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