MR imaging, with its newer sequences, helps in differentiating the type of hydrocephalus and provides most details of brain and CSF pathways. 8 ), meningeal or ependymal calcifications, and occasionally syringomyelia or syringobulbia, are the sequelae of TBM. Tuberculosis of the central nervous system. Gupta RK, Gupta S, Singh D et-al. Although diagnostic evaluation includes various microbiological, pathologic, molecular, and biochemical investigations, imaging modalities have an important diagnostic role. The brain parenchyma immediately adjacent to the inflammatory exudate shows edema, perivascular infiltration, and a microglial reaction, known as border zone reaction ( Fig. Tuberculous meningitis is caused by hematogenous spread from lung infection usually with caseous necrosis, granuloma formation and endarteritis; parenchymal granulomas may coalesce and rupture into the basal cisterns. Leidy HJ, Tang M, Armstrong CLH, Martin CB, and Campbell WW. However, multidrug-resistant tuberculosis remains a major hurdle in treatment. (, TB pachymeningitis. 27 (5): 1255-73. It may manifest in a variety of forms including meningitis, parenchymal and leptomeningeal tuberculomas, abscesses, cerebritis, vasculitis, infarction, and osteomyelitis. Tuberculosis as a mimicker of brain tumour. Tubercular hydrocephalus is usually communicating, accounting for 80% of cases. Noncommunicating or obstructive hydrocephalus can occur either because of obstruction of fourth ventricular outlet foramina by the basal exudates or mass effect by a focal parenchymal tuberculoma, because of brain abscess, or because of entrapment of part of a ventricle by ependymitis ( Fig. Ileocecal involvement is seen in 80%–90% of patients with abdominal tuberculosis. 10. The exudate in the basal cisterns can cause obstruction to cerebrospinal fluid (CSF) flow, causing hydrocephalus, and can compress cranial nerves. Imaging of tuberculosis. [] Clinical diagnosis can be difficult; therefore, imaging has an important role in establishing the diagnosis (see the images below). With the onset of the human immunodeficiency virus pandemic, the incidence of tuberculosis, including central nervous system (CNS) tuberculosis, has increased in developed countries. A 37-year-old woman presented with headaches. altered sensorium, hemiparesis). 4 ). It is no longer a disease confined to underdeveloped and developing countries. Anterior distribution, particularly in the caudate nucleus and in the presence of multiple infarcts, favored a tuberculous cause, and posterior distribution indicated the possibility of associated risk factors of stroke. It is no longer a disease confined to underdeveloped and developing countries. Among all other forms of TB, central nervous system (CNS) TB accounts for approximately 1% and has the highest mortality. Kornienko VN, Pronin IN. Imaging, particularly magnetic resonance imaging, is a cornerstone in the diagnosis as well as follow-up of central nervous system (CNS) tuberculosis. It is important to diagnose pachymeningeal TB because it responds well to antitubercular treatment and thus should be considered in the differential diagnosis of pachymeningeal abnormalities. Hence, familiarity with the imaging presentations of various forms of CNS tuberculosis is essential in timely diagnosis, and thereby reducing the morbidity and mortality of this disease. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. However, similar imaging findings can be seen in various causes of inflammatory and noninflammatory conditions, especially meningioma. North Am. The imaging appearance has become more complex with the onset of multidrug-resistant tuberculosis. Pathogenesis of CNS tuberculosis Most tuberculous infections of the CNS are caused by Mycobacterium tuberculosis. CNS infection caused by Mycobacterium tuberculosis (TB) generally has a clinical presentation and imaging appearance different from that caused by typical bacteria. 1990;4 (4): 769-87. Central nervous system (CNS) tuberculosis is a potentially life threatening condition which is curable if the correct diagnosis is made in the early stages. Central nervous system (CNS) tuberculosis occurs in approximately 1% of all patients with active tuberculosis. Infratentorial tuberculomas may present with brainstem syndromes, cerebellar symptoms, and multiple cranial nerve palsies. Gupta RK, Lufkin RB. Central nervous system (CNS) tuberculosis is frequently encountered in tropical countries. Presence of hyperdensity on precontrast scans in the basal cisterns might be the specific sign of TBM in children. Cell-mediated immunity is responsible for the formation of dense, gelatinous, inflammatory exudate along the basal surface of the cerebrum. The newer imaging techniques further help to improve the characterization and diagnosis of atypical CNS TB. Services. Tuberculosis (TB) of the central nervous system (CNS) is a granulomatous infection caused by Mycobacterium tuberculosis. The affected nerve shows thickening and enhancement on postcontrast images. Tuberculous meningitis. Mild shortening of T1 and T2 relaxation times of CSF occurs as the disease progresses. BACKGROUND AND PURPOSE: CNS tuberculosis may simulate other granulomas and meningitis on MR images. There is a wide radiological and pathological spectrum of the CNS disease. Proteomics Core Facility. The epidemiology of patients with tuberculomas is the same as that of other CNS manifestations of tuberculosis (TB) (see CNS tuberculosis). Although CNS involvement by tuberculosis is seen in all age groups, there is a predilection for younger patients, with 60-70% of cases occurring in patients … Involvement of the central nervous system (CNS) is one of the most serious forms of this infection .Granulomatous inflammatory reaction in CNS caused by M. tuberculosis may involve the meninges, brain, spinal cord, and the bones Events & Courses. Parenchymal TB can occur in the form of tuberculoma, brain abscess, tuberculous encephalopathy, and tuberculous cerebritis. Mycobacterium TB is responsible for almost all cases of tubercular infection in the central nervous system. Tuberculous meningitis and intracranial tuberculous granuloma (tuberculoma) are the most common manifestations and these are discussed in detail in separate articles. Tuberculosis (TB) remains a prominent global problem especially because of the increasing incidence of human immunodeficiency virus (HIV) and drug-resistant strains, although its incidence seems to have declined recently. It shows rim enhancement on postcontrast images ( Fig. Yadav and colleagues reported a high incidence of complex hydrocephalus in patients with TBM and found it to be a cause of failure of endoscopic third ventriculostomy. Early, accurate diagnosis can help in preventing morbidity and mortality. Acta Radiol. It also helps in differentiating tuberculous meningitis from other causes of meningitis. … Differential diagnosis of CNS TB includes multiple brain metastases (which associated with more edema); sarcoidosis (which are associated with parenchymal nodules and have multiple dural and/or leptomeningeal nodules, multifocal or multicentric primary tumour,and fungal infections. Periventricular hypodensity on CT and periventricular hyperintense signal on proton density and T2-weighted (T2W) images on MR imaging indicate interstitial edema caused by periventricular ooze of CSF secondary to increase in intraventricular pressure. Imaging is essential in showing complications in addition to diagnosis of CNS TB. Modern imaging is a cornerstone in the early diagnosis of CNS tuberculosis and may prevent unnecessary morbidity and mortality. Patients usually present with headache, seizures, focal neurologic deficit, and features of raised intracranial tension. Przybojewski and colleagues evaluated these 9 criteria and showed high specificity for all the criteria, and 100% specificity for 4 individual criteria. In a follow-up case of TB meningitis, T2W axial images show disproportionate enlargement of the left lateral ventricle (, TB vasculitis with acute infarct. Radiographics. However, because these techniques are invasive and may be associated with complications, they should be used only if MR imaging is not available. Salgado P, Del brutto OH, Talamás O et-al. Khanna PC, Godinho S, Patkar DP et-al. • Approximately 10% of all patients with Tuberculosis have CNS involvement. Newer imaging techniques like magnetic resonance spectroscopy help to improve characterization and thus aid in diagnosis of atypical CNS TB. Central nervous system (CNS) tuberculosis (TB) is a dreadful form of TB which may be potentially lethal in the setting of delayed diagnosis. (2001) ISBN:0306465515. Tuberculomas are among the most common intracranial mass lesions and the most common manifestation of parenchymal TB. Imaging findings depend on the stage of tuberculoma, whether it is noncaseating or caseating with solid or liquid center. Multiple large, pale histiocytes with plump cytoplasm are seen in the center. 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