Subacute Meningitis Research Articles

The challenge of etiologic diagnosis of subacute and chronic meningitis: an analysis of 183 patients.

Subacute and chronic meningitis (SCM) presents significant diagnostic challenges, with numerous infectious and non-infectious inflammatory causes. This study examined patients aged 16 and older with SCM admitted to referral centers for neuroinfections and neuroinflammations in Mashhad, Iran, between March 2015 and October 2022. Among 183 episodes, tuberculous meningitis was the most common infectious cause (46.5%), followed by Brucella meningitis (24.6%). The cause of SCM was definitively proven in 40.4%, presumptive in 35.0%, and unknown in 24.6% of cases. In-hospital mortality was 14.4%, and 30.5% of survivors experienced unfavorable outcomes (Glasgow Outcome Scale 2-4). Patients with unknown causes had a significantly higher risk of death compared to those with presumptive or proven diagnoses (risk ratio 4.18). This study emphasizes the diagnostic difficulties of SCM, with one-quarter of cases remaining undiagnosed and over one-third having only a presumptive diagnosis. Improving diagnostic methods could potentially enhance prognosis and reduce mortality.

Primary Leptomeningeal Lymphoma in HIV-infected Patients Presented with Subacute Meningitis

Primary leptomeningeal lymphoma (PLML) is extremely rare, accounting for only 7% of all primary central nervous system lymphomas. We present a case of PLML in a person living with HIV with controlled disease, presented with low cerebrospinal fluid sugar meningitis and leptomeningeal nodular enhancement, posing a diagnostic difficulty because the presentation resembled infectious diseases.

Clinical and mycological implications of cryptococcal meningitis in Iran

Cryptococcal meningitis (CM) is an uncommon and severe infection that tends to affect both immunocompromised and immunocompetent hosts. To gain insights into the clinical and epidemiological characteristics of CM in Iran, this study evaluated patients with subacute or chronic meningitis referred to 15 Iranian hospitals. Relevant clinical and epidemiological characteristics of the patients were analyzed. Diagnosis of CM cases was performed by microscopic examination, culture, latex agglutination assay, lateral flow assay, and multiplex PCR on cerebrospinal fluid (CSF) samples. The isolates were processed and subjected to molecular identification and in vitro susceptibility antifungal profile. Among the 272 evaluated patients, 7 (2.6 %) CM cases were diagnosed. Out of seven CM cases, 6 (86 %) were male with a median age of 36 years. The most common neurological signs were headache (100 %), followed by nausea and vomiting (71.4 %). All CSF samples from CM patients exhibited positive results across all mycological tests conducted. The isolates were identified as Cryptococcus neoformans (86 %) and Cryptococcus gattii (14 %). All isolates were susceptible to voriconazole and fluconazole, while resistance was observed with itraconazole (MIC value of 0.5 μg/mL) and amphotericin B (MIC values of 4 and 1 μg/mL). The highest mortality (6/7, 86 %) was observed among patients. While a comprehensive study on this subject is currently lacking in Iran, the data acquired through this research play a crucial role in enhancing the clinical and epidemiological understanding of this infection, particularly within low-income countries. Moreover, these findings will serve as a cornerstone for future international comparative studies in this field.

Características clínicas y diagnósticas de tuberculosis meníngea en adultos, Bogotá (Colombia)

Resumen
 Introducción: La infección por Mycobacterium tuberculosis es una enfermedad con presencia mundial, cuya principal manifestación clínica es pulmonar; la tuberculosis meníngea es la segunda presentación extrapulmonar más frecuente después de la pleural y ocasiona alta morbimortalidad, pero un diagnóstico y tratamiento tempranos disminuyen estos desenlaces.
 Objetivo: Establecer las características clínicas de pacientes con tuberculosis meníngea en nuestras instituciones y la evaluación de los resultados obtenidos con los métodos diagnósticos disponibles.
 Materiales y métodos: Se realizó un estudio observacional descriptivo de corte transversal, mediante revisión de historias clínicas de pacientes con tuberculosis meníngea en el periodo 2003-2012, en dos instituciones de tercer y cuarto nivel de atención en Bogotá.
 Resultados: Se evaluaron 36 pacientes con tuberculosis meníngea, con edad media de 52,4 años, 63,8% sexo masculino y 16,6% coinfección con virus de inmunodeficiencia humana. La presentación clínica subaguda y crónica fue de 49,9%; 86,1% tuvieron cefalea; otros síntomas fueron: fiebre, rigidez nucal. En líquido cefalorraquídeo, todos tuvieron hiperproteinorraquia y 88,8% hipoglucorraquia. En estudios microbiológicos 71,8% tuvieron adenosin deaminasa positiva, 30,4% reacción en cadena de polimerasa positiva y 41,1% cultivo positivo. La hiponatremia fue de 36,1%. En neuroimágenes 18,7% presentaron hidrocefalia y 17,6% paquimeningitis.
 Conclusión: La tuberculosis meníngea representa hoy un reto diagnóstico, ya que no existe un método disponible con las características ideales de una prueba diagnóstica, debiendo considerarse las manifestaciones clínicas de meningitis subaguda o crónica y los hallazgos en líquido cefalorraquídeo primordiales para el diagnóstico e inicio temprano del tratamiento.

Clinical manifestations of Lyme neuroborreliosis in children: a review.

Lyme neuroborreliosis (LNB) is a manifestation of Lyme disease involving the central and peripheral nervous system. It is caused by the spirochete Borrelia burgdorferi, transmitted by tick bites to a human host. Clinical signs of LNB develop after the dissemination of the pathogen to the nervous system. The infection occurs in children and adults, but the clinical manifestations differ. In adults, painful meningoradicultis is the most common manifestation of LNB, while children often present with facial nerve palsy and/or subacute meningitis. Subacute headache can be the only manifestation of LNB in children, especially during the summer months in Lyme disease-endemic regions. Non-specific symptoms, such as loss of appetite, fatigue or mood changes, may also occur, especially in young children. A high level of suspicion and early recognition of the various clinical manifestations presented by children with LNB is essential to minimize delay in diagnosis and optimize management. This review provides an overview of the spectrum of clinical manifestations, and discusses diagnosis, antibiotic treatment, and clinical outcome of LNB in children.

Case Report: Lesson Learned from Delayed Definitive Treatment of Stage 4 HIV Patient with Cerebral Toxoplasmosis – A Case Report

Background: Cases of cerebral toxoplasmosis continue to burden people living with HIV/AIDS (PLWHA). This surge in cases is primarily due to patients’ delayed definitive treatment, missed follow-up, and insufficient diagnostic equipment in some regions, particularly in developing countries such as Indonesia.Case Presentation: We report on a 35-year-old male referred to the emergency department with impairment in four extremities from a secondary healthcare facility. Specific atypical symptoms that mimicked subacute meningitis were identified during the physical examination. Internists, neurologists, and rehabilitation medicine professionals were associated with the management.Conclusion: We suggest that improved early diagnosis and treatment of HIV patients to prevent opportunistic infections, including cerebral toxoplasmosis, is needed, particularly in primary healthcare facilities in developing countries.

Evaluation of the epidemiologic, clinical, radiologic, and treatment methods of patients with subacute and chronic meningitis

BackgroundMeningitis is known as a meningeal inflammation accompanied by pleocytosis in the cerebrospinal fluid (CSF), and can be classified into acute, subacute, and chronic meningitis based on symptoms duration of ≤ 5 days, ≥ 5 days and ≥ 4 weeks, respectively. Subacute and chronic meningitis are caused mainly by indolent infectious agents and noninfectious causes such as autoimmune, and neoplastic. In this study, we investigated the characteristics, diagnosis, and treatment of subacute and chronic meningitis.MethodsWe extracted the medical records of patients with chronic and subacute meningitis who were referred to three tertiary centers from Jun 2011 to Jun 2021. Initially, 2050 cases of meningitis were screened, and then 79 patients were included in the study.ResultsHeadache (87.3%), nausea and vomiting (74.7%), fever (56.4%), and visual impairments (55.7%) were the most prevalent symptoms. The most common signs were nuchal rigidity (45.3%), altered mental status (26.9%), and papillary edema (37.5%). Brain computed tomography (CT) was normal in 68.6% of the patients while 22.9% of the cases had hydrocephalus. Brain magnetic resonance imaging (MRI) was normal in 60.0% of the patients. The most common abnormal MRI findings were leptomeningeal enhancement (16.0%) and hydrocephalus (16.0%). We had a 44.3% definite diagnosis with bacterial (n:25, 31.6%) and neoplastic (n:8, 10.1%) being the most prevalent etiologies. Mycobacterium tuberculosis (60%) and Brucella spp. (12%) were the most prevalent bacterial pathogens.ConclusionsThe most common etiologies include infectious, neoplastic, and immunologic. Due to insidious presentation and uncommon etiologies, establishing a proper diagnosis, and providing timely targeted treatment for patients with subacute and chronic meningitis remains a challenge for clinicians.

Bone marrow invasion by cryptococcus in HIV infected patients with asymptomatic meningitis: a case report

Cryptococcal infection is one of the common opportunistic fungal infections seen in HIV patients. It is the second leading cause of mortality in Acquired Immuno deficiency Syndrome (AIDS) patients worldwide. The cryptococcal infection occurs in subacute meningitis, patients having CD4+ T Lymphocytes count below 100 cells/micro liter. However, in severe immunosuppressed patients, Cryptococcus neoformans can infect any human organ including the bone marrow. This case presents the disseminated cryptococcosis with bone marrow involvement and asymptomatic meningitis, focusing on the role of bone marrow aspirate and biopsy study in HIV infected patients. A 42 year old HIV infected male patient with a CD4+ T Lymphocyte count of 25 cells/μl was admitted to the emergency department of Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India. The patient underwent a CSF examination to rule out the infection of meningitis patient had no signs of meningeal irritation and neurological examinations were normal. The CSF culture showed Cryptococcus sp. The patient was given Amphotericine B plus Fluconazole therapy according to IDSA guidelines. However, the patient developed acute kidney injury stage 3 and was given fluconazole monotherapy. The symptoms disappeared and CSF culture for fungi was negative after 2 weeks of treatment. Bone marrow infection caused by Cryptococcus neoformans is a rare presentation of cryptococccosis.

Integrating central nervous system metagenomics and host response for diagnosis of tuberculosis meningitis and its mimics

The epidemiology of infectious causes of meningitis in sub-Saharan Africa is not well understood, and a common cause of meningitis in this region, Mycobacterium tuberculosis (TB), is notoriously hard to diagnose. Here we show that integrating cerebrospinal fluid (CSF) metagenomic next-generation sequencing (mNGS) with a host gene expression-based machine learning classifier (MLC) enhances diagnostic accuracy for TB meningitis (TBM) and its mimics. 368 HIV-infected Ugandan adults with subacute meningitis were prospectively enrolled. Total RNA and DNA CSF mNGS libraries were sequenced to identify meningitis pathogens. In parallel, a CSF host transcriptomic MLC to distinguish between TBM and other infections was trained and then evaluated in a blinded fashion on an independent dataset. mNGS identifies an array of infectious TBM mimics (and co-infections), including emerging, treatable, and vaccine-preventable pathogens including Wesselsbron virus, Toxoplasma gondii, Streptococcus pneumoniae, Nocardia brasiliensis, measles virus and cytomegalovirus. By leveraging the specificity of mNGS and the sensitivity of an MLC created from CSF host transcriptomes, the combined assay has high sensitivity (88.9%) and specificity (86.7%) for the detection of TBM and its many mimics. Furthermore, we achieve comparable combined assay performance at sequencing depths more amenable to performing diagnostic mNGS in low resource settings.

Amyloid-\u03b2 related angiitis presenting as eosinophilic meningitis: a case report

BackgroundEosinophilic meningitis is uncommon and often attributed to infectious causes.Case presentationWe describe a case of a 72-year-old man who presented with subacute onset eosinophilic meningitis, vasculitis, and intracranial hypertension with progressive and severe neurologic symptoms. Brain MRI demonstrated multifocal strokes and co-localized right temporo-parieto-occipital vasogenic edema, cortical superficial siderosis, and diffuse leptomeningeal enhancement. He ultimately underwent brain biopsy with immunohistochemical stains for amyloid-β and Congo red that were extensively positive in the blood vessel walls and in numerous diffuse and neuritic parenchymal confirming a diagnosis of amyloid-β related angiitis. He was treated with immunosuppression with clinical stabilization.ConclusionsAmyloid-β related angiitis is an underrecognized cause of eosinophilic meningitis that can present fulminantly and is typically responsive to immunosuppression. The presence of eosinophils may provide additional clues to the underlying pathophysiology of amyloid-β related angiitis.

Next-Generation Sequencing-Based Diagnosis of Bacteremic Listeria monocytogenes Meningitis in a Patient with Anti-Interferon Gamma

Abstract Although various opportunistic infections have been described in patients with anti-interferon gamma autoantibodies, so far there is no Listeria monocytogenes infection reported to be associated with this primary immunodeficiency. Here, we describe the first case of bacteremic L. monocytogenes meningitis in a 59-year-old Chinese man with anti-interferon gamma autoantibodies, who presented with acute onset of fever and severe headache. Blood culture was positive but culture of the cerebrospinal fluid was negative, although it showed features suggestive of partially treated bacterial meningitis. The presence of L. monocytogenes in the cerebrospinal fluid was confirmed by next-generation sequencing. Avoidance of high-risk food items in these patients is important for the prevention of listeriosis. The use of antibiotic regimens that cover Listeria is crucial for empirical treatment, particularly if such patients develop acute or subacute meningitis. Next-generation sequencing is becoming an important diagnostic modality for culture-negative infections.

‘When Cryptococcus strikes and lupus is found’: a unique covert unveiling of systemic lupus erythematosus presenting as subacute meningitis

Cryptococcal neoformans is a rare fungal pathogen that has been associated with immunocompromised individuals. Due to its rare occurrence, clinicians have a low index of suspicion for diagnosis, which can lead to increased morbidity and mortality. We present an 81-year-old fully functional woman with no known predisposing risk factors or previous immunocompromising conditions who was found to have cryptococcal meningitis on cerebrospinal fluid analysis in the setting of newly diagnosed uncontrolled type 2 diabetes and systemic lupus erythematosus (SLE).

Stroke in a Patient with Recurrent Meningeal Tuberculosis and HIV Coinfection

Recurrent tuberculous meningitis can have a non-specific clinical presentation when it presents as a co-infection with HIV and can resemble other causes of subacute and chronic meningitis, leading to unwanted outcomes; for this reason, timely diagnoses are required. The most widely used microbiological diagnostic methods can be of low sensitivity or have delayed results. The aim of this article is to present a clinical case of recurrent tuberculous meningitis with a clinical presentation of stroke due to a basal cistern ischaemic lesion in a patient co-infected with HIV, who had a microbiological confirmation and a drug sensitivity study with phenotypic and molecular tests.

Lyme Neuroborreliosis in Children

Lyme neuroborreliosis (LNB) is an infectious disease, developing after a tick bite and the dissemination of Borrelia burgdorferi sensu lato spirochetes reach the nervous system. The infection occurs in children and adults but with different clinical courses. Adults complain of radicular pain and paresis, while among the pediatric population, the most common manifestations of LNB are facial nerve palsy and/or subacute meningitis. Moreover, atypical symptoms, such as fatigue, loss of appetite, or mood changes, may also occur. The awareness of the various clinical features existence presented by children with LNB suspicion remains to be of the greatest importance to diagnose and manage the disease.

Genetic predictors of cytokine response in ENT-associated encephalitis

(1) Introduction: An imbalance of the genetically determined cytokine response plays a key role in the etiology of ENT-associated encephalitis. In recent years, an attempt has been made to evaluatethe prognostic role of chronic pathology of the paranasal sinuses in the development of acute, subacute and chronic encephalitis and meningitis, which in clinical practice are manifested both as cerebral and focal neurological symptoms and as mental disorders: from borderline to psychotic ones. The problem requires a multidisciplinary approach on the part of the specialists in the following clinical disciplines: neurology (as well as neurobiology), psychiatry, immunology, experimental medicine, otorhinolaryngology, and pharmacogenetics. The solution of this problem is possible with the involvement of preventive and personalized medicine.(2) The purpose: Evaluation the prognostic role of genetic polymorphisms of pro- and antiinflammatory cytokines in the development of ENT-associated encephalitis.(3) Materials and Methods: We conducted a keyword-based analysis of the English and Russian-language articles published within the past 30 years (from 1988 to 2018). The following databases were used in the study: PubMed, MedLine, Web of Science Core Collection (Clarivate Analytics), Web Science, Russian Science Citation Index, Scopus, Scientific Research, Google Scholar, Oxford Press, and eLibrary.(4) Results: In a number of the analyzed works, regardless of the causative agent and viral load, an increased level of pro-inflammatory cytokine production was noted in patients with more severe disease progression, neurological complications and unfavorable outcomes, both in viral encephalitis and in bacterial one. Based on this, 30 single nucleotide variants (SNV), their influence on the expression of pro- and anti-inflammatory cytokine genes, as well as their predictor role in the development of ENT-associated encephalitis were analyzed. Due to the nature of the systemic immune response, the analysis included both cerebral and extracerebral pathology-associated SNV. The inconsistency of the previously obtained results was noted, an attempt to explain this phenomenon was made. The analysis of the dynamics and geography of publications on the stated topic was made, the leading Russian scientific centers in the field were defined. The most promising SNV for further studies were identified.(5) Conclusion: The risk of developing ENT-associated encephalitis is associated with a genetically determined status of the cytokine response and its regulation. Studies of the association of various SNV of genes encoding pro- and anti-inflammatory cytokines in the Russian Federation need to be continued.

Meningitis due to Roseomonas in an immunocompetent adolescent

Both bacterial and aseptic meningitis can complicate neurosurgery, but they are often difficult to distinguish clinically or by cerebrospinal fluid (CSF) analysis. We present an adolescent with subacute meningitis after neurosurgery, eventually diagnosed with meningitis caused by Roseomonas mucosa via 16S rRNA gene sequencing after two negative CSF cultures. He was treated successfully with intravenous meropenem with full recovery. This case shows that distinguishing bacterial from aseptic meningitis is important to allow directed antibiotic therapy. We recommend considering bacterial meningitis in the differential diagnosis of aseptic meningitis complicating neurosurgery, and to perform molecular diagnostics such as bacterial sequencing if the suspicion of bacterial meningitis is high.

Isolated neurobrucellosis-characteristic clinical and laboratory features.

To report various neurological syndromes, CSF findings, imaging and diagnostic methods used in neurobrucellosis patients admitted in our Neurology department over a period of 6years. Case records of patients admitted to our department from August 2014 to May 2020 were searched for neurobrucellosis and data were obtained. A total of 19 patients were diagnosed as neurobrucellosis over a period of 6years. Ten patients had chronic meningitis, five had VIII nerve involvement, one had optic neuritis, two had acute meningitis, one had subacute meningitis, four had myelopathy, five had polyradiculitis and two had spondylodiscitis. CSF was abnormal in 17 patients. Neutrophilic pleocytosis was seen in 12 patients who included nine patients with chronic symptomatology.Brain imaging was abnormal in three chronic meningitis patients. One had diffuse meningeal enhancement, another had hydrocephalus while the third patient had meningeal enhancement with basal exudates and contrast enhancement of bilateral VIII nerve. One of the patients of acute meningitis had hydrocephalus while the other one had bilateral T2/FLAIR hyperintensities with enhancement of meninges and leptomeningeal vessels. Elevated antibody titers only in serum was seen in six patients while elevated antibody titers only in CSF was seen in seven patients. Four patients had elevated antibody titers in both serum and CSF. CSF culture was positive in three patients. Neurobrucellosis is a rare clinical complication of brucellosis but may pose a problem in diagnosis as it can mimic tuberculosis. Involvement of VIII nerve and neurophilic pleocytosis in CSF despite chronic symptomatology can be diagnostic clues favoring neurobrucellosis.

Emergence of Different Autoimmune Diseases Including a Behçet's disease in a Sibling After tick bites. Remarkable cure of Behcet's disease by a Combination of Antibiotics and Hydroxychloroquine

We report therein the onset of three chronic diseases: Behcet's disease, fibromyalgia and rheumatoid arthritis in three sisters after tick bites. Only Behcet's disease was treated in our department. After failure of the initial treatment including colchicine and corticoids, the patient recovered within a prolonged antibiotic therapy time period of 18 months. A 23-year-old female patient was admitted to hospital in the Infectious Diseases Department as she presented with headache, diffuse inflammatory arthromyalgia, abdominal pain and cutaneous folliculitis, and for the umpteenth time for several past years, meningeal syndrome recurrence. The physical examination was unremarkable. The biological test assessment was normal, as were the ophthalmological and cerebral MRI examinations. The patient’s HLA B5 test was negative. The upper digestive fibroscopy shown digestive ulcerations. The diagnosis of Behcet's disease was made on the following: inflammatory arthralgias, digestive ulcerations, folliculitis lesions; recurrent bipolar aphthosis was found at patient’s interview. The patient was given prednisone 0.5 mg/kg/day and colchicine 1 mg/day. The evolution was characterized by an initial improvement of clinical symptoms followed by further iterative recurrence as soon as the corticosteroid doses were reduced. Upon resuming the interview with the patient’ s mother, clinical symptoms began at the age of 9 years old by the occurrence of a voluminous cutaneous erythema following multiple tick bites. One month later the patient presented with subacute lymphocytic meningitis, which was treated as tuberculosis meningitis without relevant bacteriological evidence. On the same day, the patient's two sisters were also bitten by ticks. A few weeks later on, one of them developed osteomyelitis of the tibia, which was operated on. The bacteriological examination result was negative, the histological examination showed non-specific osteomyelitis. Subsequently, she developed various multiple functional complaints that led to the diagnosis of fibromyalgia. Her other sister concomitantly developed seronegative rheumatoid arthritis. The diagnosis of chronic post-tick bite syndrome was suspected despite the negativity of the Lyme serology. The patient significantly improved thanks to high-dose of intravenous penicillin G, despite an initial exacerbation during the first month of treatment, which could be interpreted as confirmation of an infectious process (Jarisch-Herxheimer reaction). Corticosteroids and colchicine were discontinued ; the patient was given doxycycline for a total duration of 18 months. Antibiotic therapy was associated with hydroxychloroquine, the same way as reported for therapy of chronic Q fever and some types of Lyme disease [1]. In 2004, the patient was in complete remission of Behcet's disease. Ten years later, no recurrence has been observed.

Autoimmune glial fibrillary acidic protein astrocytopathy manifesting as subacute meningoencephalitis with descending myelitis: a case report

BackgroundGlial fibrillary acidic protein (GFAP) autoimmune astrocytopathy is characterized by GFAP autoantibody positive encephalitis, meningoencephalitis or meningoencephalomyelitis. The initial clinical presentation may be similar to central nervous system infections making early diagnosis challenging.Case presentationA Chinese female patient presented with subacute meningitis with symptoms of headache, vomiting, and fever. Cerebrospinal fluid (CSF) analysis showed monocytic pleocytosis, elevated protein level, low glucose level, and negative basic microbiological studies including Xpert MTB/RIF. Brain magnetic resonance imaging (MRI) showed bilateral cerebral cortical and white matter hyperintensities on FLAIR sequences. The patient was diagnosed with possible tuberculous meningitis and started on anti-tuberculosis therapy (ATT). Three months later, the patient developed cervical myelopathy and encephalopathy with persistent CSF pleocytosis. Five months later, tissue-based and cell-based assays demonstrated GFAP antibodies in blood and CSF. Her symptoms improved with repeated administration of intravenous immunoglobulin (IVIG) and corticosteroids. One-and-a-half -year follow-up showed neither clinical progression nor relapses.ConclusionsAnti-GFAP astrocytopathy should be included in the differential diagnosis of patients who present with subacute meningitis with negative microbiological studies and a progressive clinical course including encephalitis and/or myelitis.

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

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.