Question

Discuss the imaging findings of tubercular meningitis.

Hint:

In cases of suspected tubercular meningitis, MRI is preferred over CT due to its higher sensitivity in detecting early changes such as meningeal enhancement.

Answer 1

Step 1: Introduction to Tubercular Meningitis.
Tubercular meningitis (TBM) is a severe form of central nervous system tuberculosis and can be fatal if not treated early. It primarily affects the meninges and brain, leading to hydrocephalus and other complications. Imaging plays a critical role in the diagnosis and monitoring of TBM.

Step 2: Imaging Findings in Tubercular Meningitis.
- CT Scan: On CT, TBM typically shows basal meningeal enhancement with hydrocephalus. The enhancement is most noticeable around the basal cisterns, which is characteristic of the disease.
- MRI: MRI is more sensitive than CT for detecting early changes. It reveals meningeal enhancement, especially along the convexity and basal cisterns, and may show signs of cerebral infarction or edema. In advanced cases, tuberculomas (small nodular masses) may be observed in the brain parenchyma.
- Other findings: Chronic TBM may lead to thickening of the meninges, hydrocephalus, and changes in the cortical and subcortical regions.

Step 3: Conclusion.
Imaging findings, especially on MRI and CT, are crucial for diagnosing tubercular meningitis. Early detection and monitoring through imaging are essential for appropriate treatment and management of the disease.