MyPACS.net: Radiology Teaching Files > Case 32812242

previously visited 090929 TUBERCULOSIS MENINGITIS
Contributed by: pedrad CSH, Radiologist, Chung Shan Medical University Hospital, Taiwan.
Patient: 11 month old male
History: Chief complain:
Conscious change (can not recognize his mother) since yesterday.
Intermittent fever and cough for one month.
Seizure, watery diarrhea with blood-tinged stool, vomitting with coffee ground in recent days.
Family history of pulmonary tuberculosis: + (his uncles).
Images:[small]larger

Fig. 1: T1Gd_axi

Fig. 2: T1Gd_sag

Fig. 3: T1Gd_sag
Findings:

1.5 Tesla MRI of brain and whole spine with T1 weighted echo train
 spin echo, T2 weighted echo train spin echo, T2 weighted fluid-attenuated
 inversion recovery echo train spin echo, diffusion-weighted echo-planar
 MR imaging with apparent diffusion coefficient maps, and with intravenous
 gadolinium-enhanced images:

1. Marked leptomeningeal enhancement along bilateral basal cisterns,
   including bilateral suprasellar, interpeduncular, pontine (arrows in
   figure 2), and ambient cisterns, and bilateral medial sylvian fissures,
   compatible with tuberculosis meningitis.
2. Besides, small contrast enhancement along spinal leptomeninges at
   thoracolumbar spine (arrow in figure 3), suggesting spinal meningitis.
3. Moderate symmetric dilatation of both supratentorial and infratentorial
   ventricular system, compatible with communicating hydrocephalus
   due to obstruction of basal cisterns by dense inflammatory exudate.

Diagnosis: Tuberculosis meningitis
(CSF culture positive for Mycobacterium tuberculosis complex)
Comments:
No comments posted.
Additional Details:

Case Number: 32812242Last Updated: 11-16-2009
Anatomy: Cranium and Contents   Pathology: Infection
Modality: MRAccess Level: Readable by all users
Keywords: tuberculosis, meningitisACR: 158.23

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