Acquired tuberculous meningitis in immunocompetent adults: contribution ofbrain imaging to diagnosis and follow-up.

We have studied 5 men, mean age 47 years, affected by tuberculous meningiti s (TM) without documented immunodepression. The diagnosis of TM was support ed by clinical and biological investigations and confirmed by the cultures of CSF. All the patients received a four-drug combination therapy and stero ids. No drug resistance of the bacilli was observed. Cerebral imaging by CT and MRI was rarely diagnostic but most useful during the follow-up. All th e patients developed complications including tuberculomas (5), hydrocephalu s (4), ischemic lesions (2), arachnoiditis (1) and abscess of spinal cord ( 1). Four patients recovered and one died. The mean duration of the follow-u p was 16 months. MRI was more sensitive than CT scan to identify inflammato ry lesions such as granulomas, angeitis or arachnoiditis and to follow thei r outcome. Tuberculomas and hydrocephalus were easily diagnosed by CT scan with contrast enhancement. Recommendations of sequential imaging are sugges ted to identify unexpected or asymptomatic complications of TM during thera py and evaluate the outcome.