Computed tomography of intracranial tuberculosis

Abstract

The many clinico-radiological manifestations of intracranial tuberculosis have been well documented; however, few long-term retrospective serial studies of large series of patients on therapy have been reported utilizing computed imaging. The computed tomographic appearance, sequential periodic evolution, and final outcome of all patients with cranial tuberculosis seen at this institution in a period of ten years have been evaluated. A total of 80 subjects with intracranial tuberculosis revealed 17.5% with Type I isolated meningeal involvement, 71.25% with Type II isolated parenchymal forms, and 11.25% with Type III compound parenchymal/meningeal lesions. Only 28.8% had concomitant manifestations of TB outside the CNS. Seventy four of these patients were followed on medical or combined medical/surgical therapy which demonstrated 24.3% (n = 18) resolution without radiographic sequellae, 66.2% (n = 49) resolution with residual stroke, atrophy and/or calcification, and 4.1% (n = 3) with persistent enhancement of the lesion(s) after two years of treatment. Four deaths occurred all of which were in patients with Type III TB. This large group of patients followed from presentation to radiologic resolution of the disease process by computed tomography yields important information on the presentation, prognosis and sequelae of intracranial tuberculosis.