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Fluid-attenuated inversion-recovery imaging of cerebral infarction associated with tuberculous meningitis
K Nogami1, S Nomura, S Kashiwagi
1Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan. c5546@stu.cc.yamaguchi-u.ac.jp
Abstract:
A 12-month-old girl presented with fever and vomiting. Cerebrospinal fluid (CSF) examination revealed an increase of mononuclear cells and Mycobacterium tuberculosis. Magnetic resonance imaging (MRI) taken two months after the onset showed cerebral infarction in the left basal ganglia, tuberculoma in the interpeduncular cistern and brain atrophy. The infarction was shown as central cystic lesions with surrounding hyperintensity in the fluid-attenuated inversion-recovery (FLAIR) image. The cystic lesions were not differentiated from surrounding lesions in T2 weighted image (T2WI) because both lesions were demonstrated as hyperintensity areas. The hyperintensity lesion shown in FLAIR image may indicate border zone encephalitis. The FLAIR image is more useful than T1 or T2WI to detect the extension of the infarcted area and circumscribed change.
Insights
Tuberculosis meningitis in infants can cause severe neurological damage, including cerebral infarction and brain atrophy. Fluid-attenuated inversion-recovery (FLAIR) MRI sequences are crucial for detecting the full extent of brain injury.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Tuberculosis meningitis is a serious infection that can lead to severe neurological complications in infants.
- Early diagnosis and appropriate imaging are critical for managing the condition and its sequelae.
Observation:
- A 12-month-old infant presented with fever and vomiting, leading to the diagnosis of tuberculosis meningitis based on cerebrospinal fluid analysis.
- Cerebral infarction in the left basal ganglia, tuberculoma, and brain atrophy were observed via magnetic resonance imaging (MRI) two months post-onset.
Findings:
- MRI revealed central cystic lesions with surrounding hyperintensity in the fluid-attenuated inversion-recovery (FLAIR) sequence, indicative of cerebral infarction.
- T2-weighted imaging (T2WI) showed hyperintensity but could not differentiate cystic lesions from surrounding areas, unlike FLAIR.
- FLAIR imaging proved more effective than T1 or T2WI in delineating the extent of infarction and associated changes, potentially suggesting border zone encephalitis.
Implications:
- This case highlights the significant neurological impact of tuberculosis meningitis in infants.
- FLAIR MRI is a valuable tool for assessing the extent of brain damage in these cases.
- Prompt recognition and advanced imaging can aid in understanding and managing the severe neurological consequences of infant tuberculosis meningitis.