Diverse Manifestations of Central Nervous System Tuberculosis: Magnetic Resonance Imaging (MRI) Presentations and Laboratory Investigations in a Cohort Study.

OBJECTIVES

This study aims to evaluate and characterize the diverse MRI findings in central nervous system (CNS) tuberculosis (TB) and the role of other laboratory investigations to aid in early detection and appropriate management.

MATERIALS AND METHODS

This retrospective, cross-sectional study analyzed clinical and imaging data from 43 patients with confirmed CNS TB. The diagnosis was confirmed through cerebrospinal fluid (CSF) analysis, biopsy, or clinical and radiological improvement post-antitubercular therapy (ATT). MRI findings were categorized into meningeal and parenchymal forms, with further subtyping based on lesion characteristics. Chi-square statistics were performed using IBM SPSS Statistics for Windows, version 27 (IBM Corp., Armonk, New York, United States) to correlate CNS TB with clinical parameters.  Results: The mean age of the 43 patients was 33 years, and 58% were male. The most common clinical symptoms were headache (86%) and fever (79%). MRI findings revealed meningeal TB (leptomeningitis and pachymeningitis) and parenchymal TB (tuberculomas, tubercular abscesses, cerebritis, rhombencephalitis, and encephalopathy). Frequent observations included ring-enhancing lesions and perilesional edema. Parenchymal tuberculomas showed varying stages. Advanced imaging techniques such as magnetic resonance spectroscopy and perfusion imaging were useful in differentiating tuberculomas from neoplastic and infectious differentials.

CONCLUSION

CNS TB presents with diverse MRI patterns, including both typical and atypical manifestations. Accurate radiological assessment, combined with clinical correlation, is essential for early diagnosis and management. Prompt initiation of ATT is critical in preventing long-term neurological complications. Future research should focus on refining imaging biomarkers to improve diagnostic accuracy.