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ISSN: Print -2349-0977, Online - 2349-4387
PICTORIAL ESSAY - CLINICS IN NEURORADIOLOGY
Year : 2017  |  Volume : 4  |  Issue : 3  |  Page : 174-185

Central nervous system tuberculosis: Rare presentations of a common disease


Department of Radiodiagnosis, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Correspondence Address:
Mahesh Kumar Mittal
Department of Radiodiagnosis, Safdarjung Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/astrocyte.astrocyte_71_17

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Tuberculosis (TB) is a highly prevalent disease in developing countries of the world such as India. Central nervous system (CNS) involvement by TB can produce devastating effects and can be parenchymal, meningeal, intraventricular, subdural, or extradural. Common modes of CNS involvement include leptomeningitis and intracranial tuberculomas. Similar involvement of the spinal cord can produce tubercular arachnoiditis and intramedullary spinal tuberculomas. Atypical locations of tuberculomas include basal ganglia, brainstem, corpus callosum, and extra-axial and suprasellar locations. Uncommon modes of CNS involvement include tubercular pachymeningitis, focal tubercular cerebritis, cerebral abscess formation, and miliary TB. Tubercular pachymeningitis can also involve the dural lining of the spinal cord. We have presented cases of CNS TB, both atypical forms of common presentations as well as uncommon presentations with findings on magnetic resonance imaging (MRI) presenting a diagnostic dilemma. The radiologist plays a central role in the diagnosis of CNS TB in such cases, and careful tailoring of the MRI examination based on the clinical picture of the patient can play a vital role in making the diagnosis, even in atypical presentations.


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