Localized basal meningeal enhancement in tuberculous meningitis.
BACKGROUND
Focal basal meningeal enhancement may produce a confusing CT picture in children with suspected tuberculous meningitis (TBM).


OBJECTIVE
To demonstrate the incidence, distribution and appearance of localized basal meningeal enhancement in children with TBM.


METHODS
CT scans of patients with definite (culture proven) and probable (CSF suggestive) TBM were retrospectively evaluated by two observers. Localized basal enhancement was documented as involving: unilateral cistern of the lateral fossa (CLF), unilateral sylvian fissure, unilateral CLF and sylvian fissure in combination, unilateral CLF and sylvian fissure with ipsi- or contralateral ambient cistern and isolated quadrigeminal plate cistern.


RESULTS
The study included 130 patients with TBM (aged 2 months to 13 years 9 months). Focal basal enhancement was seen in 11 patients (8.5%). The sylvian fissure was involved most commonly, followed by the lateral fossa cistern. The ambient cistern was involved in three patients and the quadrigeminal plate cistern in one. Focal areas of enhancement corresponded to the areas of infarction in every patient.


CONCLUSIONS
Focal basal meningeal enhancement is common (8.5%) in paediatric TBM. This must be kept in mind when evaluating CT scans in children presenting with focal neurological findings, seizures or meningism in communities where TBM is endemic.
Theron
Salomine
S
Department of Radiology, Tygerberg Hospital, University of Stellenbosch, P.O. BOX 19063, Tygerberg 7505, South Africa.
Andronikou
Savvas
S
Grobbelaar
Marie
M
Steyn
Freda
F
Mapukata
Ayanda
A
du Plessis
Jaco
J
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008578:Meninges / Q000000981:diagnostic imaging* / Q000473:pathology; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014390:Tuberculosis, Meningeal / Q000000981:diagnostic imaging* / Q000473:pathology