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Brain study on child with TB and meningitis suspected

Case Study
Jonker, Thea Philips Healthcare South Africa
Swan, Martin, Dr. Ngwelezana Hospital South Africa

Patient history:

Three-years-old HIV+ child with pulmonary TB on treatment, temperature spikes, stiffness, drop in level of consciousness. Obvious focal neurological signs. Meningitis is suspected.

MR examination:

Because of the child's instability, relatively fast brain scans were done while maintaining good resolution:

 

FLAIR axial

T2W sagittal and coronal

T1 TSE pre- and post contrast with reduced scan times were done.

 

Total scan time, including post-contrast studies, was less than 9 minutes.

MR images and interpretation:

Axial FLAIR Coronal T2W Sagittal T1W
Axial FLAIR
Coronal T2W
Sagittal T1W

  Click on an image to enlarge it

 

  On the T1W images a hypointense lesion is seen in the basal ganglia.

  On the FLAIR images the lesions remain hypointense with surrounding hyperintense, caseating

  granuloma. Areas of subtle low signal are seen in the basal ganglia areas and parenchyma

  related to arthritis/ischemia.

 

Axial T1W <br>Post contrast Coronal T1W <br>Post contrast Sagittal T1W <br>Post contrast
Axial T1W
Post contrast
Coronal T1W
Post contrast
Sagittal T1W
Post contrast

  Click on an image to enlarge it

 

  The post-contrast T1-weighted images show basilar meningitis surrounding the circle of Willis,

  middle, posterior and anterior cerebral arteries.

 

  Intense enhancement of the basal cisterns, sylvian fissures and to a lesser extent the cerebral

  sulci is seen.

 

  A ring enhancing lesion can be seen next to the posterior communicating aretery on the right,

  and there are several solid enhancing lesions seen in the region of the pons.

Working diagnosis:

Perivascular extention of the meningitis is seen, with small hyperintense lesions in the region of the brain stem suggesting a miliary spread.

There is evidence of ventriculitis

The Cavum septum pellucidum and cavum vergae can be seen.

 

Additional comment:

The present examination suggests hematogenous spread from the pulmonary TB to the CNS.



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Feb 7, 2006

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Case Study
Achieva 1.5T
Release 1
Nova, Nova Dual, Pulsar
Brain, Neuro, Pediatric
 

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