Neuro_MR_Brain: 22 mo F, TB.

MRI BRAIN WITH AND WITHOUT CONTRAST:

CLINICAL HISTORY: 22 months of age, Female, evaluate for TB meningitis.

FINDINGS:

There is extensive leptomeningeal enhancement along the surface of the visualized upper cervical cord as well as the medulla and pons, within the cerebellar sulci, along multiple cranial nerves including the bilateral nerves VII and VIII, trigeminal nerves, oculomotor nerves, and along the optic chiasm and proximal optic nerves. There is thick leptomeningeal enhancement within the posterior right sylvian fissure and overlying the posterior medial left frontal lobe in the interhemispheric fissure. 

There are multiple parenchymal nodules within the cerebellum and bilateral cerebral hemispheres which may be leptomeningeal or cortical in location. Parenchymal enhancing nodules are seen in the cerebellar hemispheres, left pons, left midbrain, right putamen, and posterior limb of the right internal capsule. Larger parenchymal lesions show mild surrounding edema. No associated mass effect. Ventricles are normal in size. No acute infarct or hemorrhage.

IMPRESSION:

1.  Extensive leptomeningeal nodular enhancement with parenchymal nodules as above described, appearance is compatible with clinical concern of TB meningitis with parenchymal involvement, also consider additional atypical infection such as fungal infections. No hydrocephalus.

Leptomeningeal enhancement = pial-arachnoid enhancement

See: Pachymeningeal enhancement (dural enhancement)