A 32-year-old man with stupor, fever, and cranial nerve palsies.
A
B
C
What is your diagnosis?
The answer is Tuberculous Meningitis
Tuberculous meningitis is the most common form of CNS TB infection.
The mycobacteria lodge in the pia and may rupture into the subarachnoid space, forming an exudate.
Common imaging findings include thick nodular enhancement in the basal cisterns and Sylvian’s fissures (A and B, arrows).
Common complications include communicating hydrocephalus (due to obstruction of CSF resorption by inflammatory exudates) and ischemic infarcts of the midbrain, basal ganglia, and internal capsules (C, arrows), complicating vasculitis, and occlusion of small perforating vessels.
Clinical presentation can help distinguish TB meningitis from mimickers such as sarcoidosis or leptomeningeal carcinomatosis.
Cryptococcal meningitis has dilated perivascular spaces and basal ganglia pseudocysts on imaging.
中文版：
男性，32歲，木僵、發熱、顱神經麻痺
診斷：結核性腦膜炎
結核性腦膜炎是中樞神經系統結核中最常見的一種疾病。
位於軟腦膜內的結合桿菌，破裂後進入蛛網膜下腔，形成滲出物。
影像表現：基底池、外側裂池內增厚的結節樣強化灶（A,B箭頭）。
併發症：交通性腦積水（炎性滲出物阻礙腦脊液吸收），中腦、基底節區、內囊缺血性腦梗塞（C圖箭頭），可合併血管炎以及小穿支動脈閉塞。
臨床症狀有助於將結核性腦膜炎與其他疾病作鑑別，比如：結節病、軟腦膜癌。
而隱球菌性腦膜炎影像表現為血管周圍間隙擴大以及基底節區假囊腫形成。
From AJNR Classic Case