Cranial Tuberculosis Research Articles

Tuberculous Osteitis of the Cranial Vault: A Case Report

Cranial tuberculosis is a rare condition, constituting 0.2 to 1.3% of bone tuberculosis cases, mainly affecting the frontal and parietal bones. It is often misdiagnosed. A case involved a two-year-old girl, F.R., who developed ulcerations on her scalp due to multifocal tuberculosis. Imaging revealed a hypoechoic collection and mixed lesions in the parietal area, leading to a confirmed diagnosis. Common symptoms in children include painless scalp swelling and sinus discharge. Imaging, particularly CT and MRI, is critical for diagnosis and treatment planning. Early detection is essential for effective management.

The many faces of intracranial tuberculosis: atypical presentations on MRI—a descriptive observational cohort study

BackgroundAtypical MRI findings of cranial tuberculosis can lead to prolonged delay in diagnosis resulting in high costs to evaluate for alternative diagnoses. The aim of this study was to describe a series of cranial tuberculosis patients with spectrum of MRI features, other than hydrocephalus, parenchymal tuberculomas, and leptomeningeal thickening. The final diagnosis was made based on CSF findings, clinical findings, and/or marked improvement after antitubercular treatment.ResultsA total of 39 patients met the inclusion criteria and were diagnosed with vasculitis (n = 15), tubercular abscess (n = 5), miliary tuberculosis (n = 3), tubercular cerebritis (n = 9), sellar and parasellar tuberculosis (n = 7), mass forming tuberculosis (n = 1), choroid plexitis (n = 2), and intraventricular tuberculomas (n = 1).ConclusionA significant number of patients of cranial tuberculosis can have variable presentations and may be misdiagnosed. This analysis helps to reinvestigate the spectrum of MRI findings.

Evaluation of the Various Clinical Presentations of Adult CNS Tuberculosis

Background: Central nervous system (CNS) involvement is one of the most important extrapulmonary manifestations of tuberculosis (TB) causing considerable mortality and morbidity. Presentations of CNS TB are extremely variable. Treatments are generally more effective if the disease can be detected early. This study is to find out the various clinical patterns and investigation findings that might help in early detection of CNS TB.
 Objective: This study was conducted to detect various clinical manifestations of adult CNS TB at an earlier stage of evaluation.
 Methods: This was a hospital based observational study (cross sectional type) conducted on 30 patients of CNS TB who were admitted in Sir Salimullah Medical College Mitford Hospital, Dhaka during a period of 6 months from October 2013 to April 2014
 Results: Among the participants 53% were male and 47% were female, with a male female ratio of 1.13: 1. Mean age of the participants was 35.17±6.14 years. Tuberculosis involving brain (i.e. cranial TB) was most common (30.4%) in 15-24 years age group whereas spinal form of TB was most common (42.8%) in 25-34 years age group. Mean age of the participants having Brain TB was 36.46±6.90 years. Mean age of the participants having spinal TB was 32.36±12.52 years. Highest number of the cranial forms of TB was tuberculoma (52.2%) in this study and was found mostly in the young adults. Spinal TB was found in 25-34 years age group in highest number, all but one were Potts disease. Tuberculoma and tuberculous meningitis had an equal distribution in female sex while males had a higher (53.8%) occurrence of tuberculoma. On the other hand, spinal involvement was commoner in male sex (43.5%).Fever was the most common symptom noted in all forms of CNS TB patients (78.26% for brain and 71.43% for spinal cord TB patients) followed by headache and loss of consciousness representing 2nd and 3rd common symptom in brain TB patients. Most common clinical signs in brain TB were signs of meningeal irritation (65.22%), cranial nerve palsies and papillodema while spastic paraparesis with sensory level being the commonest in spinal cases. Tuberculoma was the most frequent neuro-radiologic findinds in case of brain TB patients and paraspinal soft tissue shadow with vertebral collapse was commoner in spinal TB patients.
 Conclusion: This study has highlighted the relative frequency of various types of brain and spinal TB lesions along with the symptoms, signs and laboratory findings in Bangladeshi adult patients. In Bangladesh, tuberculosis should be always an important differential diagnosis in patients of fever with headache as well as spastic paraplegia or quadriplegia for any duration in any sex group.
 J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 76-84

Role of 18F-FDG PET in demonstrating disease burden in patients with tuberculous meningitis

ObjectiveTo study the role of 18fluoro-deoxy glucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan in documenting the disease burden in patients with tuberculous meningitis (TBM), and compare these findings with conventional imaging and magnetic resonance imaging (MRI). Subjects and methodsTen patients with definite TBM were prospectively recruited. The severity of TBM was graded into stage I to III. The patients were subjected to whole body 18F-FDG PET/CT imaging and MRI brain. 18F-FDG PET/CT results were compared with the findings of brain MRI and other convectional imaging modalities (ultrasonography of abdomen and chest radiograph). ResultsThere were ten patients with TBM whose median age was 27 (14–55) years, and the median duration of illness was 4 (0.5–8.0) months. Two patients were in stage I, six in stage II, and two in stage III meningitis. 18F-FDG PET/CT confirmed the cranial MRI findings in six patients, revealed additional brain lesion in one and did not detect the existing MRI lesions in three patients. 18F-FDG PET/CT however detected additional lesions in vertebrae, spinal cord and lymph nodes which were not seen on the conventional imaging. Conclusion18F-FDG PET/CT has a complementary role to MRI for detection of cranial lesions and is more sensitive in detecting the extra cranial tuberculosis burden in the patients with TBM.

CT SCANS OF CRANIAL TUBERCULOSIS

Tuberculosis of the central nervous system is still an important cause of death or significant neurologic disability. Prompt diagnosis and early treatment are extremely important to reduce its morbidity and mortality. The main forms of intracranial tuberculosis are represented by tuberculous meningitis, meningeal or parenchymal tuberculomas, and tuberculous abscess formation. Sequelae consist of hydrocephalus, calcifications, and areas of encephalomalacia. Less frequent manifestations include tuberculous osteitis of the skull and tuberculous otomastoiditis. Although MR imaging is in general somewhat more sensitive to the detection of cranial tuberculosis, CT is the diagnostic imaging mainstay in many clinical settings to demonstrate the various aspects of cranial tuberculosis on initial presentation and to monitor the evolution of the disease and response to therapy.

Computed tomography of intracranial tuberculosis

The many clinico-radiological manifestations of intracranial tuberculosis have been well documented; however, few long-term retrospective serial studies of large series of patients on therapy have been reported utilizing computed imaging. The computed tomographic appearance, sequential periodic evolution, and final outcome of all patients with cranial tuberculosis seen at this institution in a period of ten years have been evaluated. A total of 80 subjects with intracranial tuberculosis revealed 17.5% with Type I isolated meningeal involvement, 71.25% with Type II isolated parenchymal forms, and 11.25% with Type III compound parenchymal/meningeal lesions. Only 28.8% had concomitant manifestations of TB outside the CNS. Seventy four of these patients were followed on medical or combined medical/surgical therapy which demonstrated 24.3% (n = 18) resolution without radiographic sequellae, 66.2% (n = 49) resolution with residual stroke, atrophy and/or calcification, and 4.1% (n = 3) with persistent enhancement of the lesion(s) after two years of treatment. Four deaths occurred all of which were in patients with Type III TB. This large group of patients followed from presentation to radiologic resolution of the disease process by computed tomography yields important information on the presentation, prognosis and sequelae of intracranial tuberculosis.

Computed tomography in cranial tuberculosis

Twelve patients with proven tuberculosis were studied by computed tomography. Three had tuberculomas and nine had tuberculous meningitis. Although a definite diagnosis is often not possible on CT, the method is of value in determining number, location and extent of lesions. In patients with tuberculous meningitis, CT is helpful in assessing the degree of hydrocephalus and in evaluating the effectiveness of antituberculous therapy.