Presentation
Four weeks history of Headaches, low-grade fever, and recently altered mental status.
Patient Data
Thickening with enhancement of the basal subarachnoid cisterns, cranial nerves and along the middle cerebral arteries to the Sylvian fissures well-demonstrated on postcontrast sequences (delayed T1 and T2 FLAIR fat sat). Moderate dilatation of the 3rd and lateral ventricles with periventricular transependymal edema suggestive of obstructive hydrocephalus.
Left temporoparietal lesion of low signal on T1, high signal FLAIR and T2 with a central area of the low signal which shows a nodular enhancement on post contrast sequences.
Case Discussion
The clinical presentation and the MRI features are suggestive of tuberculous meningitis with cerebral tuberculoma. Chest x-ray and abdominopelvic ultrasound (not shown) were normal.
The patient went on to have a lumbar puncture with CSF analysis that confirms the tuberculosis origin.
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