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A 17-year-old female on anti-tubercular therapy for pulmonary tuberculosis presented with headache and recurrent episodes of vomiting for 3 months. She had multiple episodes of generalized tonic-clonic seizures with progressive deterioration of sensorium for 1 week prior to hospitalization. Neurological examination revealed meningeal irritation signs and papilloedema in both eyes. The cerebrospinal fluid analysis demonstrated lymphocytic pleocytosis with low glucose and highly elevated protein levels. Contrast-enhanced MRI of the brain showed numerous small, enhancing, discrete and coalescent lesions scattered in the brainstem, basal ganglia and bilateral cerebral and cerebellar hemispheres as well as upper cervical cord (Panel C, D; arrow). Most of the lesions were isointense in T1 weighted imaging (T1WI) (Panel A; arrow) and hypointense in T2 weighted imaging (T2WI) …
Contributors UC prepared and edited the entire manuscript and was involved in direct care of the patient. PB helped with the collection of the images and relevant laboratory investigations necessary for treatment as well as documentation of the case. AC supervised the entire procedure of preparing the manuscript as well as supervised the treatment. AKR helped in the preparation of the manuscript, relevant revision and editing. All authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Consent obtained directly from patient(s).
Provenance and peer review Not commissioned; externally peer-reviewed.
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