The radiology of intracranial tuberculosis in children

Radiology provides valuable clues to the correct diagnosis of intracranial tuberculosis. Twenty-three children with this problem were reviewed. Fifteen had meningitis, 12 of whom had abnormal chest radiographs, nine of them suggestive of tuberculosis. Common neuroradiologic findings were minor suture separation, abnormal activity in the region of the sylvian fissure on brain scans, mild ventricular dilatation, and vasculitis. Among the eight patients with tuberculomas, abnormal chest radiographs were less common. Neuroradiologic abnormalities included evidence of increased intracranial pressure on skull radiographs, focal deep lesions on brain scans, and hydrocephalus and mass lesions on air studies. Most tuberculomas were calcified one year later.

Computed tomography in cranial tuberculosis

Twelve patients with proven tuberculosis were studied by computed tomography. Three had tuberculomas and nine had tuberculous meningitis. Although a definite diagnosis is often not possible on CT, the method is of value in determining number, location and extent of lesions. In patients with tuberculous meningitis, CT is helpful in assessing the degree of hydrocephalus and in evaluating the effectiveness of antituberculous therapy.

Intracranial tuberculomas and the CAT scan

Tuberculomas of the brain are rare in the United States. Although CAT (computerized axial tomography) scanning cannot distinguish these infections from other intracranial mass lesions, it provides a non-invasive technique with which to follow the course of presumptive lesions during medical therapy, and with which to search for clinically unsuspected infections. The necessity for and timing of surgery can be considered more easily with this technique. Two cases are presented with their CAT scans, including one example of the disappearance of a presumptive tuberculoma, during appropriate medical therapy.

Carotid angiography in Port Moresby. A report of a 5 year experience

During a 5 year period at Port Moresby General Hospital in Papua New Guinea. 140 patients had carotid angiograms. Three quarters of the patients were male. Average age for all patients was 29 years. 44% of the patients had detectable abnormalities, the commonest being subdural haematoma and neoplasm. Other abnormalities found included aneurysm, brain abscess, tuberculoma and thrombrosed middle cerebral artery. The findings show many similarities to a reported series in Nigeria but differs from a Uganda series in which haemotoma was much more commonly found.

Clinical and roentgenographic spectrum of pulmonary tuberculosis in the adult

In order to define the roentgenographic manifestations of pulmonary tuberculosis in the adult, we reviewed a 12 month experience with newly diagnosed patients with active pulmonary tuberculosis in two Boston hospitals. Of 88 patients, 30 (34 per cent) presented with roentgenographic manifestations other than those associated with "usual" postprimary disease. At least 12 patients (13.5 per cent) had primary tuberculosis, including two subjects over 60 years of age. Six patients (6.8 per cent) had disease confined to the lower lung fields, eight patients (9 per cent) had tuberculomas and four (4.5 per cent) had miliary tuberculosis. Twenty per cent of the patients were totally asymptomatic. With the shift of tuberculosis care to community hospitals, knowledge of the varied roentgenographic manifestations is of increasing importance for the practicing internist.

Cranial and intracranial tuberculosis

The radiographic appearances of cranial and intracranial tuberculous lesions are reviewed. The manifestations of cranial and intracranial tuberculosis vary according to the location, severity of involvement and the chronicity of the disease.

[Successfully operated case of posterior fossa tuberculoma in childhood (author's transl)]

A case of intracerebellar tuberculoma is described in which a tuberculoma was removed successfully through the administration of antituberculous agents, and a full recovery was obtained. The patient was a 3-year-old boy who had been receiving antituberculous agents for about 4 months because of acute inflammation followed by osteomyelitis of his right big toe, which was suspected to be tuberculous, and because of pulmonary tuberculosis diagnosed in a chest roentgenogram taken about 1 month after osteomyelitis was cured. While his osteomyelitis was being treated, disturbance in his gait, due to progressive spastic paraparesis, was not iced, and thereafter left cerebellar symptoms with impairment of equilibrium appeared additionally. Then, he was reffered to our clinic for further neurosurgical examination, and was admitted on November 1, 1974 after right carotid and vertebral angiography was performed via the right axillar artery, in which findings suggesting left cerebellar tumor and internal hydrocephalus were obtained. After he was admitted to our clinic, a diagnosis of tumor of the left cerebellum and internal hydrocephalus was more precisely confirmed by pneumoventriculography. Suboccipital craniectomy was then carried out and the tumor, weighing 60 gm, was completely removed from the left cerbellar hemisphere. The tumor was confirmed as tuberculoma not only by histological findings but also by the vertification of tuberculous bacilli in it. Though, moderate fever lasted for about 2 weeks postoperatively, no obvious meningitic signs or new neurological deficits were noted. The patient showed marked improvement especially in his gait disturbance, and was discharged ambulatory 40 days after the operation, and has since been asymptomatic except for slight ataxic gait. The antituberculous agents have been continuously administered postoperatively.

Cerebral tuberculoma localized by EMI scan

A case of isolated supratentorial tuberculoma is described. The patient had a left facial palsy, left hemiplegia, and left proprioceptive and stereognostic deficits with negative studies until the lesion was delineated with computerized axial tomography (EMI scan). The characteristics EMI scan is helpful in delineating the nature and precise location of the lesion prior to surgery.

Computerized axial tomography in paediatric neurology and neurosurgery

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Mediastinoscopy. Its application in central versus peripheral thoracic lesions

In an attempt to ascertain the value of mediastinoscopy in peripheral lung lesions, records of 157 patients undergoing cervicomediastinal exploration (CME) at Wilford Hall USAF Medical Center were reviewed. Among patients with benign lesions, CME was positive in 90.6% of those who had central lesions and 58.3% of those with peripheral lesions. It was positive in all 7 patients who had peripheral lesions with associated mediastinal nodes on roentgenogram and negative in all 5 who had peripheral lesions without nodes. In the patients with malignant lesions, CME was positive in 72.9% of those who had central lesions and 58.1% of those with peripheral lesions. It was positive in 24 of 27 patients who had peripheral lesions with associated mediastinal nodes and negative in 15 of 16 patients with peripheral lesions without nodes. Although we recognize this to be a selected series, CME does appear to be valuable in patients with central lesions and peripheral lesions with mediastinal nodal involvement on roentgenogram. It does not appear to be as useful in those with peripheral lesions who do not have central nodal involvement.

Tuberculoma of the brain stem: control of relapses by steroid therapy. Case report

✓ A tuberculoma is reported, with an acute onset and a recurring course of remissions. The successful use of steroid therapy is discussed.