A Behaviour and Awareness Disturbance: About Cerebral Lesions

Authors: Formigo M*, Costa M, Martins J, Sarmento H and Cotter J

Volume 4, Issue 2

Abstract

67-year-old man presented with headache, anorexia and tonic-clonic seizures. He was previously hospitalized due to miliary tuberculosis and was currently medicated with 4-drug antituberculous therapy. At admission he was agitated, uncooperative, feverish, presenting no neurological deficits. His lumbar puncture revealed proteinorrhachia, normal white blood cells count and glucose levels. MRI revealed multiple small nodular contrast-enhanced lesions with vasogenic edema in both cerebellar hemispheres, protuberance, right thalamus, bilateral frontal and parietal cortex, and left temporalis and a cavitated with gadolinium ring enhancement. A month later, cerebral spinal fluid molecular test was positive for Mycobacterium tuberculosis (MT) complex and he is currently completing antibacillary treatment with good evolution. Miliary tuberculosis may occur in both primary and reactivated tuberculosis, resulting from lymphohaematogenous dissemination of MT. Tuberculous meningitis and parenchymal lesions are the main presentations of CNS affection. The development of tuberculomas during appropriate antituberculous therapy is poorly understood and may correlate to an enhanced host immune response.

Keywords: Tuberculosis; Magnetic Resonance Imaging; Tuberculous Meningitis; Tuberculoma; Antituberculous Therapy

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