Revisiting the tubercular zone: A poor prognostic finding on neuroimaging

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Background:

• Central nervous system tuberculosis (CNS TB) represents 1-2% of all tuberculosis cases.
• CNS TB is associated with significant morbidity and mortality.
• Early diagnosis and treatment are crucial for managing tuberculous meningitis (TBM).

Observation:

• A 37-year-old female presented with prolonged fever, headache, and altered sensorium.
• Dystonic posturing of all limbs was observed, with the left side more affected.
• The patient's condition worsened despite standard antitubercular therapy and supportive care.

Findings:

• Brain MRI revealed diffusion restriction in the right caudate nucleus, anterior limb of the internal capsule, genu, and anteromedial thalamus.
• These findings are consistent with tubercular zone infarctions.
• The patient unfortunately died, highlighting the severity of the condition.

Implications:

• Tubercular zone infarctions are indicative of a grave prognosis in TBM.
• These infarctions serve as critical indicators of morbidity and mortality.
• Understanding these radiological signs is vital for patient management and outcome prediction.