Pediatric and adult meningeal, parenchymal, and spinal tuberculosis: A neuroimaging review

Clinical and radiological characteristics of parenchymal and meningeal spinal tuberculosis

BACKGROUND

Spinal tuberculosis is a rare condition that can result in significant neurological impairments. It is typically classified into two main types based on the anatomical involvement: parenchymal and meningeal. However, existing studies have not provided systematic reports that clarify the differences in aetiology, pathophysiological mechanisms, and clinical presentations between these two types.

METHODS

This retrospective study includes 107 patients diagnosed with intracranial tuberculosis accompanied by spinal tuberculosis via magnetic resonance imaging (MRI) between May 2019 and May 2024 at our hospital. Patients are categorised into parenchymal and meningeal types based on radiological manifestations. Clinical symptoms, comorbidities, peripheral blood and cerebrospinal fluid laboratory indices, and MRI data are collected for both groups. Statistical analyses are performed using Chi-square tests, independent sample t-tests and non-parametric tests.

RESULTS

Parenchymal spinal tuberculosis is more frequently associated with haematogenous pulmonary dissemination, exhibits a stronger inflammatory response and is linked to poorer nutritional status. Meningeal spinal tuberculosis often co-occurs with tuberculous meningitis, with common symptoms including sensory and motor deficits and lumbar back pain. Further, MRI findings indicate that parenchymal tuberculosis predominantly features nodular lesions, whereas meningeal tuberculosis is characterised by dural linear or leptomeningeal enhancement.

CONCLUSION

Significant differences exist in the clinical and radiological manifestations of parenchymal and meningeal spinal tuberculosis, and MRI enhancement scans play a crucial role in diagnosis, aiding in the optimisation of diagnostic and treatment strategies.

Pediatric non-congenital central nervous system infections: role of imaging in the emergency department

Neurological emergencies in pediatric patients, including central nervous system infections like meningitis and encephalitis, account for significant morbidity and mortality. Neuroimaging plays an important role in the management of these infections, especially when children present with non-specific symptoms such as fever, seizures, or altered consciousness. While computed tomography scans are typically the initial imaging step, magnetic resonance imaging is preferred for its superior detail and lack of ionizing radiation. Radiologists play a crucial role in guiding clinicians to select the appropriate imaging modality based on clinical presentation, patient age, and available technology. Optimizing techniques for these studies may help to give an overview of imaging protocols and an optimal diagnostic algorithm for these patients. In this article, we delineate the prevalent radiological manifestations associated with the primary etiological agents of central nervous system infections, encompassing bacteria, fungi, viruses, and parasites. Furthermore, we share our clinical experience with particular radiologic findings in select pathologies, underscoring the critical importance of evaluating these non-congenital infections within the context of emergency medical care.

Intracranial manifestations of central nervous system tuberculosis in children

Tuberculosis remains a significant global health challenge, with central nervous system tuberculosis (CNS-TB) posing a substantial threat, accounting for 1-10% of all tuberculosis cases. This article explores the diverse manifestations of CNS-TB in children, with a particular focus on tuberculous meningitis and tuberculomas, as well as their associated complications. Diagnostic imaging, including CT and MRI, plays a crucial role in the early detection of CNS-TB. The article emphasizes the pivotal role of imaging in the diagnosis and management of these manifestations, underscoring the importance of early recognition by healthcare professionals. Ultimately, raising awareness among pediatric radiologists, pediatricians, and pediatric neurologists is crucial for prompt intervention and improved outcomes in cases of CNS-TB.

Special Considerations in Pediatric Endoscopic Skull Base Surgery

Originally pioneered in adults, endoscopic endonasal approaches for skull base pathology are being increasingly applied as a minimally invasive alternative for young children. Intrinsic anatomic differences between these patient populations have sparked discussions on the feasibility, safety, and efficacy of these techniques in pediatric patients. This work aims to serve as a primer for clinicians engaged in the rapidly evolving field of pediatric endoscopic skull base surgery. A succinct overview of relevant embryology, sinonasal anatomy, and diagnostic workup is presented to emphasize key differences and unique technical considerations. Additional discussions regarding select skull base lesions, reconstructive paradigms, potential surgical complications, and postoperative care are also highlighted in the setting of multidisciplinary teams.

Targeted Six-Week Intensive Physiotherapy for a Case of Tuberculous Meningitis With a Syndrome of Inappropriate Antidiuretic Hormone Secretion

Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis (TB) characterized by the invasion of Mycobacterium tuberculosis into the meninges surrounding the brain and spinal cord. It triggers an intense inflammatory response, leading to neurological complications if not promptly and adequately managed. TBM often precipitates muscle weakness, neurological deficits, respiratory challenges, swallowing difficulties, joint contractures, and pain. Physiotherapy intervention is essential in treating these problems by personalized treatment strategies and treatment plans to enhance muscle strength, motor control, coordination, and overall mobility. This case report aims to highlight the significant role of physiotherapy in improving the quality of life (QOL) and functional abilities of patients with TBM. The current case report reviews the case of a 73-year-old male who presented with complaints of generalized weakness and difficulty in swallowing. The patient had a history of fever for the last six months. Magnetic resonance imaging (MRI) and high-resolution computed tomography (HRCT) diagnosed the case as TBM with miliary TB. Six weeks of targeted intensive rehabilitation program was designed according to the patient's impairments initiated from the intensive care unit (ICU) phase. The main goals of physiotherapy were to start early bed mobility, maintain joint integrity, improve postural strength and swallowing, and make the patient independent in transfer and activities of daily living (ADLs). After a six-week intensive physiotherapy (TIP-6) program, the patient exhibited significant improvements in muscle strength and independence in ADLs. This case highlights the critical role of physiotherapy in enhancing the QOL and functional abilities of patients with severe TB-related conditions.