Estimation of role of CT scan and MRI in diagnosis of tuberculosis of brain and spine.

Background: Tuberculosis of the brain and spine is a very severe disease and causes increased rate of mortality and morbidity. Its diagnosis is a challenge for physicians worldwide. Patients of different age groups and having varied socio-economic status suffer from neurotuberculosis which need to be evaluated successfully to help the physician with further management of the condition. Aim: To estimate role of CT scan and MRI in diagnosis of tuberculosis of brain and spine. Material and methods: Patients referred to the Radiology Department with any kind of neurological symptoms, coincidental finding of neurotuberculosis or even those with already diagnosed cases of neurotuberculosis which needed follow up radiological investigations were evaluated with either CT or MRI or sometimes both (These were performed on 1.5 T Philips MRI and Seimens 16 Slice MDCT machine). Results: Patients with intracranial tuberculosis mainly presented with tuberculous meningitis and tuberculomas. Most patients suffering from spinal infection presented with Pott’s spine. Most of the lesions were paradiscal with involvement of the articular discs. MRI is more sensitive than CT scan in the diagnosis of intracranial tuberculosis. MRI is also very sensitive in the diagnosis of intracranial. tuberculosis as compared to CT. CT had no significant role in the diagnosis of Spinal tuberculosis. Hence, MRI is the preferred choice of investigation while evaluating neurotuberculosis.

Neurotuberculosis as a Cause of Obesity.

Childhood obesity, taking the form of pandemic in the present era owing to the food habits, lifestyle etc, is the main cause of adult onset diseases. Obesity is the major risk factor for insulin resistance and diabetes, hypertension, cancer, gall bladder disease, and atherosclerosis in adulthood. Obesity being multi-factorial various genetic, anatomic, environmental factors are implicated to its etiognesis. While evaluating the causes of obesity in a child, in addition to the common causes, diseases involving hypothalamus should not be overlooked. We are discussing here a 9 year male child who reported to us for obesity and neurotuberculosis as the etiology was established.

Neurotuberculosis mimicking brain tumour; A case report.

Summary: Neurotuberculosis is one of the grave complications of primary tuberculous infection. Extensive BCG vaccination of children and inadequate antituberculous drug therapy have led to the emergence of newer complex clinical pictures and diagnostic dilemma. Here we report a case of right-sided hemiparesis with features of raised intracranial tension in a sixyear- old boy. Neuroimaging revealed presence of a high grade astrocytoma. On clinical examination, right-sided cervical lymphadenopathy with discharging sinus and tenderness over right hip joint were present. On further investigation, these were proved to be of tubercular origin. All preliminary findings were in favour of disseminated tuberculosis, but the nature of CNS lesion was creating diagnostic dilemma. Etiological diagnosis of the CNS lesion was necessary, as, if it was not of tubercular origin, the management protocol would be different and with any delay we could have lost the patient. Though on routine CSF study, no AFB were present, but we confirmed the presence of mycobacterial DNA by polymerase chain reaction. Patient showed considerable improvement after being put on Anti-tubercular Treatment (ATT) and steroids. Tuberculous brain abscess is rare. Very few cases have been reported even in adults. Most reported cases are in immunocompromised patients. This case highlights the fact that tuberculous brain abscess can have atypical presentation even in immunocompetent children mimicking CNS malignancy. Careful examination and thorough investigation are required to establish the diagnosis. Timely initiation of appropriate therapy can reduce mortality and neurological sequelae.