Role of magnetic resonance imaging (MRI) in tuberculous meningitis (TBM)

Abstract

Background: Tuberculous meningitis (TBM) is a life-threatening disease which leads to a high mortality rate if not timely treated. On the other hand, if the treatment is started early the response is often good. Magnetic resonance imaging (MRI) is often one of the initial investigations performed in these cases. We aim to evaluate the role of MRI in the management of TBM. Methods and materials: This was a prospective study undertaken between 2007 and 2015 in which we studied all cases of TBM that underwent MRI which was performed with and without contrast. A total of 200 patients were diagnosed with TBM based on clinical criteria, cerebrospinal fluid analysis and response to anti-tuberculous treatment were included in this study and were analysed with MRI. Results: We studied 200 patients; all had subacute lymphocytic meningitis on CSF analysis. There were 180 patients who had various neuroimaging abnormalities and only 20 patients had normal MRI findings. Communicating Hydrocephalus and abnormal meningeal enhancement were the two common neuroimaging findings. Other major findings included basal exudates, vasculitic infarcts, enhancing tuberculomas, abscesses, oedema and less commonly calcified granulomas. Conclusion: MRI has a significant role in management of CNS tuberculosis. It not only aids in making the initial diagnosis but is also a valuable means of monitoring the course of the disease under treatment.