Disseminated tuberculosis

120 views525y Female10/9/2026

Clinical Presentation

Acute onset confusional state with past history of fever, cough and abdominal pain.

1Scattered bilateral reticular and nodular shadows more evident at the right middle and lower zone
2Pre and post contrast CT of the brain showing right occipital and bilateral parietal cortical and subcortical hypodensity with subtle nodular heterogeneous enhancement in the right occipital region as well a linear ring-like enhancement see in the para-midline parietal regions bilaterally
3TB meningitis with ring-enhancing parenchymal lesions (tuberculomas).Multiple focal T2 and FLAIR hypointense lesions in the right occipital, bilateral parietal para-sagittal and bilateral cerebellar regions with related variable degrees of vasogenic oedema
4The related vasogenic oedema can be clearly demonstrated after CSF signal is attenuated
5The lesions are iso to hypointense on T1
6The related oedema reflects hypointense signal
7However, there is linear meningeal and gyriform T1 hyperintense signal in the right occipital region as well as scattered heterogeneous hyperintensities at the para-sagittal parietal regions.Increased ADC values, confirming no diffusion restriction.Intense post contrast peripheral ring enhancement of the previously described lesions (tuberculomas) together with evident thickened enhancing meninges at the right occipital cortex, right tentorial leaflet and posterior aspect of the falx
8Multiple signal void areas are appreciated coinciding with the hyperintensities demonstrated on non-enhanced T1, confirming the hemorrhagic nature of this signal
9Meningeal involvement is clearly demonstrated
10Some of the lesions (tuberculomas) are also seen to be dural-based