Neuroimaging of central nervous system tuberculosis

Area of Science:

• Neurology
• Infectious Diseases
• Pediatrics

Background:

• Central nervous system (CNS) tuberculosis is a severe form of Mycobacterium tuberculosis infection.
• Bacillus Calmette-Guérin (BCG) vaccination status can influence tuberculosis presentation and incidence.
• Delayed diagnosis of CNS tuberculosis is associated with poorer neurological outcomes.

Purpose of the Study:

• To report a severe case of CNS tuberculosis in a young child.
• To emphasize the diagnostic challenges and neuroimaging findings in pediatric CNS tuberculosis.
• To highlight the importance of early suspicion and treatment initiation for improved outcomes.

Main Methods:

• Case report of a 20-month-old unvaccinated female with suspected CNS tuberculosis.
• Diagnostic workup included cerebrospinal fluid (CSF) analysis, tuberculin skin test, interferon-gamma release assay, and CSF/respiratory/gastric polymerase chain reaction (PCR).
• Neuroimaging utilized brain magnetic resonance imaging (MRI) and computed tomography (CT) to assess CNS involvement.

Main Results:

• The patient presented with fever, cough, neurological deficits (drowsiness, Romberg's sign), and CSF abnormalities.
• Neuroimaging revealed vasculitis, hydrocephalus, and basal meningeal enhancement, characteristic of CNS tuberculosis.
• Microbiological tests confirmed Mycobacterium tuberculosis in CSF, bronchoalveolar lavage, and gastric aspirate.

Conclusions:

• This case underscores the severity of CNS tuberculosis, even in low-incidence settings.
• A combination of clinical suspicion, microbiological confirmation, and characteristic neuroimaging is key for diagnosis.
• Despite treatment, the patient experienced significant neurological sequelae, emphasizing the need for early intervention.