Summary
The contribution of MRI is reported in four adult patients with tuberculous meningoencephalitis (TbM) and with autopsy correlation in one. Contrast-enhanced T1-weighted MRI revealed the characteristic basal meningeal inflammation of TbM and its focal spreading into adjacent brain. Mixed and T2-weighted pulse sequences delineated a plethora of parenchymal abnormalities. Their relation to TbM was established by a close matching of the patient's neurological findings, contrast enhancement or a change in lesion size. The latter accurately reflected the clinical course in all patients. It remained difficult, however, to distinguish between ischaemic and inflammatory changes, which in some locations were intermixed even histologically. From our experience and that of other groups. MRI provides more diagnostic information in TbM than CT. Moreover, MRI promises to be a useful tool for monitoring treatment response.
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References
Amigo MC, Cebrian E, Castro A, Castillo J, Lema M (1980) Computed tomography in a verified case of tuberculous meningitis. Neurology 30:682
Arimitsu T, Jabbari B, Buckler RE, DiChiro G (1979) Computed tomography in a verified case of tuberculous meningitis. Neurology 29:384–386
Bhargava BS, Gupta AK, Tandon PN (1982) Tuberculous meningitis — a CT study. Br J Radiol 55:189–196
Boissonnas A, Gaudouen C, Sereni D, Sicard D, Christoforov B, Modai J, Cremer GA, Pequinot H, Laroche C (1984) La meningite tuberculeuse de l'adulte. Elements diagnostiques: analyse de 32 observations. Ann Med Interne (Paris) 135:507–511
Bullock MRR, Welchman JM (1982) Diagnostic and prognostic features of tuberculous meningitis on CT scanning. J Neurol Neurosurg Psychiatry 45:1098–1101
Bydder GM, Steiner RE, Young IR, Hall AS, Thomas DJ, Marshall J, Pallis CA, Legg NJ (1982) Clinical NMR imaging of the brain: 140 cases. AJR 139:215–236
Casselman ES, Hasso AN, Ashwal S, Schneider S (1980) Computed tomography of tuberculous meningitis in infants and children. J Comput Assist Tomogr 4:211–216
Chambers ST, Hendrickse WA, Record C, Rudge P (1984) Paradoxical expansion of intracranial tuberculomas during chemotherapy. Lancet II:181–183
Chang KH, Han MH, Roh JK, Kim IO, Han MC, Kim CW (1990) Gd-DTPA-enhanced MR imaging of the brain in patients with meningitis: comparison with CT. AJNR 11:69–76
Chu NS (1980) Tuberculous meningitis. Computerized tomographic manifestations. Arch Neurol 37:458–460
Dastur DK, Lalitha VS, Udani PM, Parekh U (1970) The brain and meninges in tuberculous meningitis — gross pathology in 100 cases and pathogenesis. Neurology (India) 18:86–100
Davidson HD, Steiner RE (1985) MRI in infections of the central nervous system. AJNR 6:499–504
Enzmann DR, Norman D, Mani J, Newton H (1976) CT of granulamatous basal arachnoiditis. Radiology 120:341–344
Fazekas F, Schmidt R, Offenbacher H, Niederkorn K, Horner S, Payer F, Lechner H (1991) Prevalence of white matter and periventricular magnetic resonance hyperintensities in asymptomatic volunteers. J Neuroimaging 1:27–30
Kingsley DPE, Hendrickse WA, Kendall BE, Swash M, Singh V (1987) Tuberculous meningitis: role of CT in management and prognosis. J Neurol Neurosurg Psychiatry 50:30–36
Kocen RS (1977) Tuberculous meningitis. Br J Hosp Med 436–445
Leiguarda R, Berthier M, Starkstein S, Nogues M, Lylyk P (1988) Ischemic infarction in 25 children with tuberculous meningitis. Stroke 19:200–204
Loizou LA, Anderson M (1982) Intracranial tuberculomas: correlation of computerized tomography with clinicopathological findings. Q J Med 201:104–114
Naheedy MH, Azar-Kia B, Fine M (1983) Radiologic evaluation of tuberculous meningitis. Invest Radiol 18:224–229
Naughten E, Weindling AM, Newton R, Bower BD (1981) Tuberculous meningitis in children. Recent experience in two English centres. Lancet I:973–975
Newman PK, Cumming WJK, Foster JB (1980) Hydrocephalus and tuberculous meningitis in adults. J Neurol Neurosurg Psychiatry 43:188–190
Price H, Danziger A (1978) Computed tomography in cranial tuberculosis. AJR 130:769–771
Rich AR (1951) The pathogenesis of tuberculosis, 2nd edn. Blackwell, Oxford
Rovira M, Romero F, Torrent O, Ibarra B (1980) Study of tuberculous meningitis by CT. Neuroradiology 19:137–141
Schoeman J, Hewlett R, Donald P (1988) MR of childhood meningitis. Neuroradiology 30:473–477
Schroth G, Kretzschmar K, Gawehn J, Voigt K (1987) Advantage of magnetic resonance imaging in the diagnosis of cerebral infections. Neuroradiology 29:120–126
Scully RE, Mark EJ, McNelly BU (1982) Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. N Engl J Med 306:91–97
Stevens M, Everett ED (1987) Sequential computerized axial tomography in tuberculous meningitis. JAMA 239:642
Suss RA, Resta S, Diehl JT (1987) Persistent cortical enhancement in tuberculous meningitis. AJNR 8:176–720
Tandon PN (1978) Tuberculous meningitis. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology. Elsevier, Amsterdam. pp 195–262
Traub M, Colchester ACF, Kingsley DPE (1984) Tuberculosis of the central nervous system. Q J Med 209:81–100
Trautman M, Kluge W, Otto HS, Loddenkemper R (1986) CT in CNS tuberculosis. Eur Neurol 25:91–97
Witham RR, Johnson RH, Roberts DL (1979) Diagnosis of miliary tuberculosis by cerebral computerized tomography. Arch Intern Med 139:479–480
Witrak BJ, Ellis GT (1985) Intracranial tuberculosis: manifestations on computerized tomography. South Med J 78:386–392
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Offenbacher, H., Fazekas, F., Schmidt, R. et al. MRI in tuberculous meningoencephalitis: report of four cases and review of the neuroimaging literature. J Neurol 238, 340–344 (1991). https://doi.org/10.1007/BF00315335
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DOI: https://doi.org/10.1007/BF00315335