PMC5465414_01
Radiologic imaging findings in a 30-year-old woman with refractory tuberculous meningitis. (a) Cranial MRI diffusion-weighted image shows acute cerebral infarction of the left putamen. (b) MRA shows stenosis in the horizontal segment of the left middle cerebral artery (arrow). (c) Chest radiograph shows miliary shadows in both lung fields. (d) On chest CT, there were diffuse ground glass opacities in both lung fields. MRI: magnetic resonance imaging, MRA: magnetic resonance angiography, CT: computed tomography
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Cranial magnetic resonance imaging (MRI) on diffusion-weighted images revealed acute cerebral infraction of the left putamen; magnetic resonance angiography (MRA) revealed stenosis of the left middle cerebral artery (LMCA) (Fig. 1a and b). Ground glass opacities in both lung fields were noted on chest radiograph and computed tomography (CT) (Fig. 1c and d).
Clinical course of a 30-year-old woman with refractory tuberculous meningitis. INH: isoniazid, RFP: rifampicin, EB: ethambutol, PZA: pyrazinamide, LVFX: levofloxacin, SM: streptomycin
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Fig. 2 shows the clinical course of the patient's hospitalization.
Cranial MRI findings of recurrent cerebral infarction in tuberculous meningitis. (a) Diffusion-weighted images show infarcted area in the left posterior limb of the internal capsule, left corona radiata, and left parietal lobe. (b) MRA shows occlusion of the left middle cerebral artery (arrow head). (c) Enhanced T1-weighted images show inflammatory changes in the base of the brain (encircled area) and venous sinus thrombosis (arrow). MRI: magnetic resonance imaging, MRA: magnetic resonance angiography
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Findings indicative of inflammation of the cranial base and lateral sinus thrombosis were also observed (Fig. 3).
Cranial MRI after intrathecal administration of INH for tuberculous meningitis complicated by cerebral infarction. Enhanced T1-weighted images show improvement of the inflammatory changes in the base of the brain (encircled area) and resolution of sinus thrombosis (arrow). MRI: magnetic resonance imaging, INH: isoniazid
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Serial cranial MRI indicated resolution of the venous sinus thrombosis and reduction of the inflammatory findings in the cranial base (Fig. 4).