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MILIARY TUBERCULOSIS OF THE BRAIN
By Dr. Humera Ahsan
Department of Radiology
Aga Khan University Hospital
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Central nervous system (CNS) involvement occurs in 2 – 5 % of all patients with
tuberculosis
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CNS TB may be observed in several forms: 1. Intracranial or spinal tuberculous granulomas
(tuberculomas) 2. Meningits 3. Tuberculous abscess formation which is
relatively rare, but can be seen in immuno compromised patients.
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The bacilli disseminate from a pulmonary source hematogenously to the cerebrum. They often lodge at the gray-white matter junction, where they may remain dorment
for years or may form tuberculous granulomas.
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INTRACRANIAL TUBERCULOMAS
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Axial T2 WT Images
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AXIAL T1 & CORONAL FLAIR
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POST CONTRAST
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MENINGITIS
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TB meningitis typically causes a thick basilar exudate that is associated with meningeal enhancement. It results in brain edema manifested by effacement of sulci. TB meningitis may cause communicating or non-communicat ing hydrocepha lus , infarctions secondary to tuberculous periarteritis.
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COMPLICATIONS
!!HYDROCEPHALUS
!! INFARCTIONS
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TUBERCULOUS ABSCESS
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TB abscess is much larger than
tuberculoma, and it is formed by semiliquid pus which contains large numbers of
organisms. TB abscess may be unilocular or
multiloculated, and it has a greater degree of surrounding edema and rim
enhancement.
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EPENDYMAL AND MENINGEAL DISEASE and CEREBRITIS
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NON SPECIFIC APPEARANCES
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CT
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Differential diagnosis of CNS TB includes multiple brain metastases (which associated with more edema); sarcoidosis (which are associated with parenchymal nodules and have multiple dural and/or leptomeningeal nodules, multifocal or multicentric primary
tumour,and fungal infections.
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CONCLUSION
!! Diagnosis is Tuberculosis based on imaging pattern, CSF examination and other supporting evidence of Tuberculosis.
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