Tuberculous encephalopathy mimicking limbic encephalitis and large intraparenchymal mass: A case report

Authors

  • Raihanah Haroon Department of Radiology, Kulliyyah of Medicine, International Islamic University Malaysia (IIUM)
  • Siti Kamariah Che Mohamed Department of Radiology, Kulliyyah of Medicine, International Islamic University Malaysia (IIUM)
  • Radhiana Hassan Department of Radiology, Kulliyyah of Medicine, International Islamic University Malaysia (IIUM)

DOI:

https://doi.org/10.31436/ijohs.v5i1.247

Keywords:

case report, encephalitis, limbic, tuberculous

Abstract

We report a 17-year-old gentleman presented with acute encephalopathy and neuropsychiatric disturbances. Contrast-enhanced CT and MRI brain revealed bilateral enhancing grey matter lesions involving both basal ganglia with perilesional oedema. The peculiarity of the lesions raising confusions whereby limbic encephalitis and intracranial masses were initially given consideration hence causing a delay in treatment. Tuberculous encephalopathy has different imaging appearances depending on the stage of maturity which will be further discussed here. Definitive treatment for this patient comprises of daily 10-months dose of anti-tuberculous drugs with prompt neurosurgical intervention if required. However, these should be delivered at a timely fashion to improve the outcome for both survival and neurological sequelae.

References

Cherian, A., Thomas, S.V. (2011). Central nervous system tuberculosis. African Health Sciences, 11(1), 116-127.

Daher, J. A., Monzer, H. T., & Abi-Saleh, W. J. (2020). Limbic encephalitis associated with tuberculous mediastinal lymphadenitis. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 18. https://doi.org/10.1016/j.jctube.2019.100129

Fernando, A., Miguel, C. (2015). Tuberculous encephalitis associated with basal ganglia lesions and movement disorder. Revista Ecuatoriana de Neurología, 24(1-3), 42-44.

Hee-Jin, K., Kyu-Won, S., Moon-Kyu, L., Moo-Suk, P., Se-Hoon, K., Eung-Yeop, K., Soochul, P., Tai-Seung, K. (2011). Tuberculous encephalopathy without meningitis: pathology and brain MRI findings. European Neurology, 65(3), 156-159. https://doi.org/10.1159/000324170

John, R.J. (1986). Focal tuberculous cerebritis. American Journal of Neuroradiology, (9), 121-124

Kelley, B., Patel, S., Marin, H., Corrigan, J., Mitsias, P., & Griffith, B. (2017). Autoimmune encephalitis: pathophysiology and imaging review of an overlooked diagnosis. American Journal of Neuroradiology, 38(6), 1070-1078. https://doi.org/10.3174/ajnr.A5086

Rock, R. B., Olin, M., Baker, C.A., Molitor, T.W., & Peterson, P.K. (2008). Central nervous system tuberculosis: pathogenesis and clinical aspects. Clinical Microbiology Reviews, 21(2), 243-261. https://doi.org/10.1128/cmr.00042-07

Sharma, P. (2015). Spectrum of atypical presentation of tubercular infections of central nervous system - case series and review of literature. Journal of Tuberculosis Research, 3(03), 90-96.

Taheri, M.S., Karimi, M.A., Haghighatkhah, H., Pourghorban, R., Samadian, M., & Kasmaei, H. D. (2015). Central nervous system tuberculosis: an imaging-focused review of a reemerging disease. Radiology Research and Practice, 1-8.

Vandana, V.A., Dayananda, S.G., Singh, T.P., Nitish, A., Shamrendra, N., Singh, M.M. (2013). MRI spectrum of CNS tuberculosis. Journal, Indian Academy of Clinical Medicine, 14(1), 83-90.

Venkatram, K., Mahesh, K.M., Mukul, S., Manohra, K., Brij, B.T. (2018). Central nervous system tuberculosis: rare presentations of a common disease. Astrocyte, 4, 174-185.

Khatri, G. D., Krishnan, V., Antil, N., & Saigal, G. (2018). Magnetic resonance imaging spectrum of intracranial tubercular lesions: One disease, many faces. Polish Journal of Radiology, 83, e628–e639. https://doi.org/10.5114/pjr.2018.81408

Downloads

Published

2024-02-29

How to Cite

Haroon, R., Che Mohamed, S. K., & Hassan, R. (2024). Tuberculous encephalopathy mimicking limbic encephalitis and large intraparenchymal mass: A case report. IIUM Journal of Orofacial and Health Sciences, 5(1), 90–95. https://doi.org/10.31436/ijohs.v5i1.247