case_images: PMC11377918_01
case_images: Neuroimaging of the patient.. Cranial computed tomography scan with contrast (A-C): Fairly defined focal areas of hypodensities seen in the deep white matter of the bilateral basofrontal parasagittal lobes, head of the left caudate nucleus, and anterior limb of the left internal capsule (A,B: white arrows), with undue leptomeningeal enhancement and mild communicating hydrocephalus (A,C: blue arrows).. Cranial MRI with contrast (D-I): Hyperintense foci with some areas of restricted diffusion and magnetic susceptibility artifacts with surrounding vasogenic edema in the cortical-subcortical junction of the bilateral basal ganglia, thalamus, midbrain and pons, bilateral temporal, bilateral parietal, left occipital lobes and bilateral frontal lobes (D-I: red arrows); with leptomeningeal and pachymeningeal nodular thickening and enhancement.
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case_images: A cranial computed tomography (CT) scan with contrast was suggestive of tuberculous meningitis with cerebritis (see Figure 1A-C). This is composed of an 11-point Diagnosis Likelihood Tool (DLT) and a Clinical Feature Scale (CFS) to guide the diagnosis, which has a corresponding likelihood and severity score, respectively.    With this criterion, our case was very likely to be PAID syndrome with a total score of more than 17 (DLT = 8 points + CFS = 13 points, with a final PSH-AM score of 21).    Cranial magnetic resonance imaging with contrast revealed a further extension of the tuberculous abscess and non-resolution of hydrocephalus (see Figure 1D-I).
case_images: 21-channel electroencephalogram.. A, B: Epoch of electroencephalogram at the start during (A), and after the paroxysmal episodes showing absence of epileptiform discharges (B) prior to the event as evidenced by muscle artifacts. C: The decerebrate posturing of the patient during the event.
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case_images: Figure 2A-C). Fentanyl drip was started due to unavailability of morphine.