Central nervous system tuberculosis: MRI findings and follow-up in 12 cases

Objective The aim of this study was to characterize the MR findings of various intracranial lesions in the central nervous system (CNS) tuberculosis. Materials and methods The MRI findings (T1, T2 and TI sequence after contrast) of IZ proved cases (10 males, 2 females, 24 to 64 years old average : 35) of CNS tuberculosis were reviewed; 4 patients rt cre seropositive for HIV. Results Several types of lesions were identified: tuberculomas called miliary lesions if they were smaller than 2 mm in diameter (7 cases), in I case the tuberculoma was revealed by two large lesions and bihemispheric localisations, leptomeningitis (5 cases), infarction (il cases), abscesses (3 cases with solitary lesions in 2/3 cases), hydrocephalus (3 cases), pachymeningitis (2 cases). A tuberculomas-leptomeningitis association was found in 4 patients. The pachymeningitis form had all unusual aspect in one case. Patients with leptomeningitis showed thick meningeal contrast enhancement involving ail basal cisterns, expanding to the sylvian fissures level, and causing narrowing of the sylvian arteries. Massive infarctions resulted from arterial englobement or embols. In three out of five patients, leptomeningitis was the initial presentation. In seropositive patients, tuberculosis was severe with high mortality (3/4 patients), and associated with other multiple lesions. Conclusion Central nervous system tuberculosis has different appearences, mostly tuberculomas and leptomeningitis. MR with contrast is necessary for follow-up during treatment.