Sumaira Nabi, Sadaf Khattak, Mazhar Badshah, Haris Majid Rajput.
Neuroradiological manifestations of tuberculous meningitis.
Pak J Neurological Sci Jan ;9(2):16-21.

Introduction: Tuberculous meningitis (TBM) represents the most severe form of extra pulmonarytuberculosis (1).The early and exact diagnosis of TBM is important but difficult due to time consuming definitive microbiological procedures (2).Neuroimaging is an important initial investigation in tuberculous meningitis(3).This study was conducted to evaluate the neuroradiological findings in patients with tuberculous meningitis, as a useful modality for itsearly diagnoses and prompt treatment. Materials and methods: A consecutive series of 100 patients diagnosed with TBM admitted to the PIMS neurology ward were studiedbetween 15thMarch 2013 and 14thApril 2014. Cranial imaging results were obtained by non-contrast enhanced CT brain (NECT) and MRI brain with contrast. Results: The mean age was 34.86 ± 17.56 years with a female preponderance (55%). On admission, 72% were in MRC stages II or III. The in-hospital mortality was 16%. NECT was obtainedin all the patients and was abnormal in 67% of the patients. The most common CT findings were hydrocephalus (58%), edema (24%) and infarcts (5%). MRI was obtained in 62% of the patients and was abnormal in 87% of these cases. Out of these patients hydrocephalus (60%), tuberculomas (53%), leptomeningeal involvement (45%)and infarcts (13%)were the most frequent signs. Tuberculomas were almost always multiple involving both the supracortical and infracortical regions. In 10% patients with a normal NECT, MRI revealed positive findings. Conclusion: Neuroimaging techniques are a handy tool in the early diagnosis of TBM. MRI is particularly helpful in defining findings, such as hydrocephalus, tuberculomas, leptomeningeal involvement, or infarcts.

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