MR imaging and angiography in tuberculous meningitis

Area of Science:

• Neurology
• Radiology
• Infectious Diseases

Background:

• Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis affecting the central nervous system.
• Cranial nerve palsies and ischemic complications are significant causes of morbidity and mortality in TBM.

Purpose of the Study:

• To evaluate the spectrum of MRI findings in patients with tuberculous meningitis.
• To specifically document cranial nerve abnormalities and vascular changes associated with TBM.

Main Methods:

• MRI was performed on 26 patients diagnosed with tuberculous meningitis.
• Magnetic resonance angiography (MRA) was utilized in 20 of these patients.
• Imaging focused on meningeal enhancement, tuberculoma detection, cranial nerve status, and vascular abnormalities.

Main Results:

• All patients exhibited meningeal enhancement; two showed ependymal enhancement.
• Tuberculomas were detected in 17 patients.
• Cranial nerve palsies were observed in 9 patients, with 7 showing nerve enhancement.
• MRA revealed arterial narrowing in 10 patients, affecting major cerebral arteries.
• Infarcts were present in 14 patients, predominantly in the basal ganglia and internal capsules.

Conclusions:

• MRI is highly sensitive in detecting meningeal enhancement and tuberculomas in TBM.
• Cranial nerve involvement and ischemic changes secondary to vasculopathy are frequent complications.
• MRI and MRA are crucial for diagnosing and characterizing the neurological sequelae of tuberculous meningitis.