tuberculous pachymeningitis

Tuberculous pachymeningitis is a rare form of CNS tuberculosis characterized by a chronic tuberculous infection leading to a dura mater involvement. Common sites of involvement are cavernous sinuses, floor of middle cranial fossa and tentorium.

This condition should not be confused with the common tuberculous leptomeningitis, which is discussed separately.

Epidemiology

The epidemiology of patients with tuberculomas is the same as that of other CNS manifestations of TB (see CNS tuberculosis).

Radiographic features

CT

• hyperattenuating solid plaque like densities (calcification may be seen)

MRI

• T1: hypointense thickened dura mater
• T2: hypointense thickened meninges
• T1 C+ (Gd): intense homogenous enhancement of thickened meninges

Treatment and prognosis

Treatment of CNS tuberculosis is based on an anti-tubercular treatment regimen. However, multi-drug resistant tuberculosis remains a major hurdle in treatment.

Differential diagnosis

General imaging differential considerations include

• neurosarcoidosis
• meningioma
• lymphoma / leukemic infiltration
• Erdheim Chester disease

Siehe auch:

• Neurosarkoidose
• Erdheim-Chester-Erkrankung
• tuberkulöse Meningitis

und weiter:

• Pachymeningeosis
• hypertrophe Pachymeningitis
• idiopathische hypertrophe Pachymeningitis