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.

CT scan; the diagnostic value of the basal enhancement in tuberculous meningitis

To study the diagnostic value of basal enhancement on computed tomography [CT scan] in differentiating tuberculous [TBM] from pyogenic [PM] meningitis. Retrospective case control study. The Pediatric department in collaboration with the department of Radiology and Diagnostic imaging of Bahawal Victoria hospital, Bahawalpur. The reports of CT scan [contrast] done within 5 days of admission of children 4 month to 14 years of age with a diagnosis of either IBM [case group] or PM [control group] were analyzed for the basal enhancement. The sensitivity specificity PPV and NPV of basal enhancement in the diagnosis of TBM was 0.97,1,1 and 0.95 respectively. The presence of the basal enhancement on CT scan can effectively distinguish TBM from PM

Intracranial menifestations of tuberculosis: an imaging study

In this paper we report various intracranial manifestations of tuberculosis in 48 patients who presented at our hospitals. The object of this study was to see different patterns of intracranial tuberculosis seen on cross sectional imaging in the city of Lahore and its suburbs. In a total of 48 patients, 21 had meningitis, 16 patients were found to have tuberculomas which also included 6 who had accompanying meningitis. Vasculitis resulting in lacunar infarcts was seen in 3 patients. Hydrocephalus was seen in 5 patients and choroid plexus tuberculosis [choroid plexitis] was seen in 3. Intracranial tuberculosis, therefore can have many presentations such as meningitis, tuberculomas or rare varieties such as abscess, cerebritis or choroid plexus involvement. It can also lead to devastating complications such as hydrocephalus and infarcts

Intradural extramedullary tuberculoma of the spinal cord: a case report

Intradural extramedullary (IDEM) tuberculoma of the spinal cord is uncommon entity and moreover, few reports have been documented on concurrent IDEM and intracranial tuberculomas. Authors report a case of IDEM spinal tuberculoma having intracranial lesion simultaneously. A 49-year-old woman suffered from paraparesis and urinary incontinence while being given medical treatment for tuberculous meningitis. Magnetic resonance imaging (MRI) revealed an IDEM mass lesion between the T1 and T2 spinal levels, and multiple intracranial tuberculous granulomas. Surgical resection of the IDEM tuberculoma followed by anti-tuberculous medication resulted in good outcome.

Value of CT scan in the diagnosis of meningitis.

OBJECTIVE: To study the diagnostic test characteristics of computed tomography (CT scan) in differentiating tuberculous (TBM) and pyogenic (PM) meningitis. DESIGN: Prospective diagnostic test evaluation. SETTING: Teaching hospital. METHODS: Children beyond 1 month of age admitted with meningitis were enrolled prospectively and CT scan done. Results of CT scan were compared with predefined gold standards for the diagnosis of either TBM or PM. RESULTS: CT scan was performed in 154 patients with meningitis. Of these 94 were TBM, 52 had PM and 8 were indeterminate and excluded from analysis. Basal enhancement, ventriculomegaly, tuberculoma and infarction were all significantly more common in the TBM group, while subdural collections were seen more in the PM group. The highest sensitivity (89.2%) and specificity (100%) for diagnosis of TBM were found for basal enhancement or tuberculoma or both. CONCLUSIONS: CT scan can be used to effectively distinguish TBM and PM.