Intracranial Tuberculosis in Children: CT Findings before and after Treatment

Jung, Hye Weon; Kim, In One; Kim, Woo Sun; Hwang, Wong Seong; Yeon, Kyung Mo

Abstract

OBJECT: To analyze the CT findings of intracranial tuberculosis in children at initial stage and during follow-up after treatment.
MATERIALS AND METHODS
We evaluated 25 patients who were diagnosed by CSF analysis or response to anti-tuberculous medication as suffering from intracranial tuberculosis. There were 13 boys and 12 girls aged between 4 months and 14 years. Twenty-five initial and sixty-three follow-up CT scans were retrospectively analyzed. We evaluated the pattern of cisternal enhancement, the locations of infarction, and the presence of calcification and parenchymal granuloma. The changes of hydrocephalus and related complications, aswell as cisternal abnormality during anti-tuberculous medication were also evaluated.
RESULTS
The initial findings on CT scan were hydrocephalus(75%), cisternal obliteration in precontrast study(64%), thick-line orring-shaped cisternal enhancement on postcontrast study(44%), infarctions(32%), calcifications(32%), periventricular edema(28%), and parenchymal granulomas(16%). On follow-up CT scan, hydrocephalus and cisternal enhancement had decreased to 35% and 82%, respectively, and the granulomas had changed to calcified nodules(100%). Ventriculo-peritoneal shunt or external ventricular drainage was needed in nine patients, and ventriculitis or complication of shunt procedure developed in four.
CONCLUSION
Intracranial tuberculosis in children presented predominantly as meningitis involving basal cisterns and was associated with hydrocephalus. Infarction and calcification may be seen as parenchymal lesion. In spite of medical treatment, drainage was needed in about half the patients. During this treatment, the resolution of hydrocephalus, decreased cisternal enhancement, and calcification of the granulomas were seen.