Extensive meningeal and prenchymal calcified tuberculoma as long-term residual sequelae of tuberculous meningitis

Abstract

A 51-year-old woman presented with progressive cognitive decline of 1 year duration. Her past medical history revealed that she received treatment for tuberculous meningitis and milliary tuberculosis at the age of twenty. At that time cerebrospinal fluid (CSF) and sputum were positive for M. tuberculosis. During that illness she had suffered from recurrent seizures. Neurological examination revealed right optic atrophy with total blindness and right spastic hemiparesis. Neuropsychological tests revealed visuospatial, verbal and visual memory deficits, and also deficits in frontal executive functions. Brain computed tomography (CT) scan and magnetic resonance imaging (MRI) showed multiple extensive popcorn-like calcifications in the basal cisterns, insula, hippocampus, and frontal corticomedullary junction along the meninges protruding into the brain prenchyma [Figures 1 and 2]. The masses showed hypointensity in all spin-echo sequences of the brain MRI [Figure 2]. These findings suggest extensive meningeal and parenchymal calcified tuberculoma as long-term sequelae of tuberculous meningitis. A large calcified nodule in the right crus cerebri was probably responsible for the blindness in her right eye and a right hippocampal head compression by the calcified lesion may relate to some of her cognitive deficits [Figure 3].