case_images: PMC10827300_01
case_images: MRI orbit pre- and post-contrast. a, b The optic nerves appear to be swollen. They show high signal intensity on T2 weighted/FLAIR (orange arrows). c, d Abnormal T1 weighted post-contrast enhancement is seen especially in the intracranial parts bilaterally (orange arrows).
case_images: crn-2024-0016-0001-536086_F01.jpg
case_images: PMC10827300_01_crn-2024-0016-0001-536086_F01.jpg
case_images: F1
case_images: Magnetic resonance imaging (MRI) of the head, spine, and orbit with contrast was done and was significant for bilateral optic neuritis with no other abnormalities identified (Fig. 1).
case_images: MRI head pre- and post-contrast. a, c Diffuse high T2 signal in the left cerebral hemisphere leptomeninges (yellow arrow) and high T2 signal of peripheral nodules with central dark T2 signal in the juxta cortical left parietal postcentral gyrus (blue arrow) and in the left cingulate gyrus (green arrows). b, d Diffuse left cerebral hemisphere leptomeningeal enhancement scattered with tiny peripherally enhancing nodules (yellow arrows) with central dark T2 signal in the juxta cortical left parietal postcentral gyrus (blue arrow) and in the left cingulate gyrus (green arrow).
case_images: crn-2024-0016-0001-536086_F02.jpg
case_images: PMC10827300_01_crn-2024-0016-0001-536086_F02.jpg
case_images: F2
case_images: However, a repeated MRI head showed findings that were suggestive of leptomeningitis with intra-axial tuberculomas (Fig. 2).
case_images: Follow-up MRI head and orbit contrast enhanced. Pre-contrast (a, c) and post-contrast (b, d): almost complete clearance of the previously described abnormal optic nerves and leptomeningeal enhancement (yellow arrows), as well as the previously noted high T2W nodule in the left cingulate gyrus (blue arrow).
case_images: crn-2024-0016-0001-536086_F03.jpg
case_images: PMC10827300_01_crn-2024-0016-0001-536086_F03.jpg
case_images: F3
case_images: The patient completed a total of 1 year of ATT and, lastly, underwent a final follow-up MRI which showed complete clearance of the initial TB radiological findings (Fig. 3).