Extensive perivascular dissemination of cerebral miliary tuberculomas: a case report and review of the literature. (December 2018)

• Record Type: Journal Article
• Authors: Machida, Munetaka; Toyoda, Keiko; Matsuda, Megumi; Sumida, Kaoru; Yamamoto, Asako; Sakurai, Keita; Oba, Hiroshi
• Is Part Of: Acta radiologica open. Volume 7:Number 12(2018)
• Publication Date: 2018-12
• Subjects: Brain -- contrast-enhanced T1-weighted image -- hydrocephalus -- magnetic resonance imaging -- miliary tuberculoma -- paradoxical response; Radiology -- Periodicals; Diagnostic Imaging -- Periodicals; Radiology; Periodicals; 616.075705
• DOI: 10.1177/2058460118817918
• Languages: English
• ISSNs: 2058-4601

Abstract

Cerebral tuberculosis (TB) presents most frequently as meningitis in the basilar cistern; however, it can also manifest in various other ways, such as localized encephalitis, abscess, and tuberculoma. Here, focusing on imaging findings, we report an immunocompetent case who demonstrated multiple parenchymal lesions and was diagnosed with cerebral TB after testing positive on QuantiFERON (QTF); her clinical signs/symptoms and laboratory findings responded well to anti-TB medication therapy. The patient was a 60-year-old woman with the chief complaints of headache and consciousness disturbance. On admission, cerebrospinal fluid (CSF) examination showed increased monocyte predominance. T2-weighted images showed multiple, widely distributed hyperintense lesions in the periventricular and deep white matter. Gadolinium-enhanced three-dimensional gradient echo T1-weighed images revealed numerous granules or faint, small, enhanced foci in lesions in the periventricular and deep white matter, central gray matter, and hippocampus. Some abnormal sulcal enhancement was detected in the pia mater, indicating meningitis. Clinically, the diagnosis was difficult to make, but as the QTF result was positive, anti-TB drugs were administered, after which both the symptoms and CSF cell count showed improvement.