tuberkulöse Pachymeningitis

Tuberculous

pachymeningitis • Cerebral miliary tuberculosis with pachymeningitis - Ganzer Fall bei Radiopaedia

Haouimi A, Cerebral miliary tuberculosis with pachymeningitis. Case study, Radiopaedia.org (Accessed on 20 Nov 2022) https://doi.org/10.53347/rID-95782 • CC by-nc-sa 3.0 (modified)

Radiopaedia • CC-by-nc-sa 3.0 • de

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.