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 vari ous intracranial lesions in the central nervous system (CNS) tuberculosis. Materials and methods The MRI findings (T1, T2 and TI sequence after contra st) of IZ proved cases (10 males, 2 females, 24 to 64 years old average : 3 5) of CNS tuberculosis were reviewed; 4 patients rt cre seropositive for HI V. Results Several types of lesions were identified: tuberculomas called milia ry 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 localis ations, leptomeningitis (5 cases), infarction (il cases), abscesses (3 case s with solitary lesions in 2/3 cases), hydrocephalus (3 cases), pachymening itis (2 cases). A tuberculomas-leptomeningitis association was found in 4 p atients. The pachymeningitis form had all unusual aspect in one case. Patie nts with leptomeningitis showed thick meningeal contrast enhancement involv ing ail basal cisterns, expanding to the sylvian fissures level, and causin g narrowing of the sylvian arteries. Massive infarctions resulted from arte rial englobement or embols. In three out of five patients, leptomeningitis was the initial presentation. In seropositive patients, tuberculosis was se vere with high mortality (3/4 patients), and associated with other multiple lesions. Conclusion Central nervous system tuberculosis has different appearences, m ostly tuberculomas and leptomeningitis. MR with contrast is necessary for f ollow-up during treatment.