CASE REPORT:

CASE SERIES OF TUBERCULOUS MENINGITIS WITH TUBERCULOMAS

Alfian Hasbi*, Sri Andreani Utomo*
*
Radiology Department Airlangga University - Dr. Soetomo Hospital, Surabaya

Background:
The incidence of tuberculosis (TB) has markedly increased in recent years. Intracranial
tuberculosis has two related pathologic processes: tuberculous meningitis and intracranial
tuberculoma.The two conditions are separate clinical entities, with only 10% of patients with
tuberculoma having tuberculous meningitis. Tuberculoma is the most common brain stem
lesion, and in underdeveloped countries, tuberculoma may account for a significant incidence
of intracranial mass lesions (15% to 50%)

Objective :

This case series aimed to summarize the clinical features, imaging characteristics, diagnostic
methods to make better early diagnosis in the future that may prevent neurologic damage

Method:
All patients used head MRI with contrast at 1.5 T Signa GE.

Result:
A 21 years old female with fever, headache, vomiting and nausea. MRI showed multiple rim
contrast enhancement lesion at right vermis and hemisphere cerebellum. Meningeal
enhancement with multiple nodul at basal cystern. A 23 years old female with seizures, severe
headache, fever. MRI showed multiple rim contrast enhancemet lesion at centrum semiovale,
corona radiate, basal ganglia, cortical-subcortical frontotemporoparietal of the right and left
with leptomeningeal enhancement and multiple nodular lesion at basal cystern. A 45 years old
male with severe headache and the left eye suddenly cannot see. MRI showed multiple rim
contrast enhancemet lesion at the gyrus rectus, orbital gyrus, cortical right frontalis. Subacute
ischemic cerebral infarction with hemmoraghic transformation and luxury perfusion with
vasculitis. A 36 years old male with seizures, severe headache, prolonged fever. MRI showed
multiple rim contrast enhancemet lesion at subcortical right frontal, left parietooccipital, right
left temporal, left insula, right deep grey matter and right left hemisphere cerebellum with
leptomeningeal enhancement and multiple nodular lesion at basal cystern. All patients received
anti-tuberculosis (TB) therapy and show significant improvement.

Conclusion:
Diagnosis of tuberculous meningitis is frequently delayed, since the signs and symptoms are
nonspecific and chest radiographs are rarely diagnostic. Head MRI is regarded as the standard
examination. MRI findings in all patients show rim-contrast enhancement at brain parenchyme
and multiple nodular lesion at basal cystern

Keywords: Meningioencephalytis Tuberculosis, Meningitis, Tuberculoma