Answer for BIR CoW 08 Oct 2023
En Plaque Tuberculoma
Findings
•Multifocal T2 hypointense gyriform thickening noted with restricted diffusion involving left precentral gryus, post central gyrus with adjacent moderate perilesional edema in left frontopartietal lobe with midline shift to right. •T2 hypointense gyriform thickening also noted in right parietooccipital lobe. •On contrast administration –multifocal gyriform enhancement in left frontoparietal lobe ,right parietooccipital lobe, bilateral sylvian cisterns. MR spectroscopy reveals tall lipid peak at 1.3ppm.
Discussion
Tuberculosis is the most common infection involving CNS. Intracranial involvement usually occurs in the form of chronic meningitis, intraparenchymal granulomatous lesions, or both. Other possi ble forms of presentation include tubercular abscess formation and tubercular cerebritis. In contrast to frequent involvement of the leptomeninges by the tubercular inflamma- tion, isolated pachymeningeal tuberculosis is notably uncommon. Pachymeningeal tuberculosis consists of either isolated dural involvement or a predominantly dural-based lesion with secondary pial or parenchymal involvement. To conclude, tuberculosis is a rare cause of pachymeningitis. Both focal and diffuse dural involvement can occur. Frequently, absence of fever or other systemic symptoms and lack of a distinctive imaging appearance make the preoperative diagnosis difficult. However, in view of the increasing prevalence of tuberculosis, tubercular pachymeningitis should be considered in the differential diagnosis of dural abnormalities. Evidence of tuberculosis elsewhere in the body, if present, may help in suggesting the diagnosis. Differential diagnosis include meningioma, lymphoma, sarcoidosis, syphilis, meningeal carcinomatosis. and intracranial fibromatosis.
Findings
•Multifocal T2 hypointense gyriform thickening noted with restricted diffusion involving left precentral gryus, post central gyrus with adjacent moderate perilesional edema in left frontopartietal lobe with midline shift to right. •T2 hypointense gyriform thickening also noted in right parietooccipital lobe. •On contrast administration –multifocal gyriform enhancement in left frontoparietal lobe ,right parietooccipital lobe, bilateral sylvian cisterns. MR spectroscopy reveals tall lipid peak at 1.3ppm.
Discussion
Tuberculosis is the most common infection involving CNS. Intracranial involvement usually occurs in the form of chronic meningitis, intraparenchymal granulomatous lesions, or both. Other possi ble forms of presentation include tubercular abscess formation and tubercular cerebritis. In contrast to frequent involvement of the leptomeninges by the tubercular inflamma- tion, isolated pachymeningeal tuberculosis is notably uncommon. Pachymeningeal tuberculosis consists of either isolated dural involvement or a predominantly dural-based lesion with secondary pial or parenchymal involvement. To conclude, tuberculosis is a rare cause of pachymeningitis. Both focal and diffuse dural involvement can occur. Frequently, absence of fever or other systemic symptoms and lack of a distinctive imaging appearance make the preoperative diagnosis difficult. However, in view of the increasing prevalence of tuberculosis, tubercular pachymeningitis should be considered in the differential diagnosis of dural abnormalities. Evidence of tuberculosis elsewhere in the body, if present, may help in suggesting the diagnosis. Differential diagnosis include meningioma, lymphoma, sarcoidosis, syphilis, meningeal carcinomatosis. and intracranial fibromatosis.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!