Tuberculous Meningitis: The Important Role of Imaging

Tuberculous meningitis is the most severe form of tuberculosis and the diagnosis continues to be challenging for clinicians. Indeed, many cases of Tuberculous meningitis cannot be confirmed based on clinical findings and laboratory techniques are largely insensitive or slow. Clinical presentation can be nonspecific and suggest alternative conditions. The difficulty in diagnosis often leads to a delay in treatment and subsequent mortality. We present a case of a four-year-old indian girl with meningitis that presented a clinical deterioration with neurological signs while under antibiotics. The epidemiological history and the neuroimaging findings of incipient hydrocephalus, infarcts and probable tuberculomas, were essential to evoke the diagnosis of Tuberculous meningitis. Diagnosis of Tuberculous meningitis is difficult as it can clinically present similarly to other forms of meningitis. The recognition of this entity involves a high index of suspicion based on the previous referred findings and is essential in terms of morbidity and mortality.