Intracranial tuberculosis in AIDS: CT and MRI findings

CT and MRI findings in 35 patients with the acquired immune deficiency syndrome (AIDS) and proven intracranial tuberculosis (TB) are presented. Over 90% of the patients were intravenous drug abusers and in two-thirds TB was the first manifestation of AIDS. CT was normal in one quarter, the most frequent findings being hydrocephalus (51%) and meningeal enhancement (41%), commonly seen together (31.5%). Meningeal enhancement was seen in 48% of the CT studies with intravenous contrast medium and in 3 cases studied with MRI and i.v. gadolinium DTPA, in 2 of which CT was negative. Parenchymal involvement was found in 37% of cases; MRI was more sensitive than CT for its detection. One quarter of the patients had ischaemic lesions, mainly in the basal ganglia. We confirm the usefulness of CT and the superiority of MRI in the diagnosis of intracranial TB and in differential diagnosis from other conditions likely to be found in these patients.