Contributed by
Black Lion Hospital, Addis Ababa University
Saba Shimelis, and Mehari Temesgen.
History
A 4-year-old child present with seizure and right-side hemiparesis.
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Question
What is the most likely diagnosis? Which MRI sequence is crucial for making the diagnosis?
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Correct answer
- CNS giant tuberculoma is the most likely diagnosis
- T2W is a crucial sequence
Discussion
A well-defined T1W iso and T2W concentric hypointense lesion in the left cerebral hemisphere that doesn't restrict on DWI/ADC. The lesion shows smooth peripheral enhancement. on post-contrast study. The imaging feature and the prevalence in the endemic area suggest that the most likely diagnosis is CNS tuberculoma. The diagnosis was established based on the contact history: the mother has a confirmed case of pulmonary tuberculosis, diagnosed 9 months ago, and has been treated with anti-TB medication. Recent lab results show a significantly elevated ESR of 100. No tissue biopsy was done. The child responded clinically after the anti-TB treatment.
Brain tumor—T2W hypointensity and no restriction on DWI are against a brain tumor.
Hematoma—No blooming artifact is seen on swi
Differential diagnosis
Brain tumor
intra cerebral hematoma
Additional images
References
- Tuberculosis: A Radiologic Review1,Joshua Burrill, FRCR ● Christopher J. Williams, FRCR ● Gillian Bain,FRCR ● Gabriel Conder, FRCR ● Andrew L. Hine, MD ● Rakesh R. Misra, FRCR Central Nervous System Tuberculosis: An Imaging-Focused Review of a Reemerging Disease Morteza Sanei Taheri,1 Mohammad Ali Karimi,1 Hamidreza Haghighatkhah,1 Ramin Pourghorban,1 Mohammad Samadian,2 and Hosein Delavar Kasmaei3 Tuberculosis from Head to Toe,Mukesh G. Harisinghani, MD • Theresa C. McLoud, MD • Jo-Anne O. Shepard, MD • Jane P. Ko, MD • Manohar M. Shroff, MD • Peter R.Mueller, MD