INTRODUCTION:Despite CNS TB infection being the common in India, we frequently encounter unusual clinic-radiological findings leading to diagnostic dilemma. In our series we highlight the rare presentations/complications of CNS TB. METHODS:Data of all children with radiologically diagnosed CNS TB during January 2021 to September 2023 was retrieved and only those with microbiological confirmation were included. RESULTS:179 children had neuro-tuberculosis, out of which (55%) are boys. Median age was 6.3yrs(4m-17yrs). 47%(82) had conventional imaging findings of leptomeningeal enhancement, hydrocephalus with basal exudates.Unusual presentations/complications of intracranial TB were: 1) Skull and meninges- 2 had skull bone osteomyelitis(occipital, frontal), 5 had pachymeningitis.

2) Parenchyma-"14% (24) had isolated tuberculomas, 3 had cerebral-abscesses, and 3 had cerebritis, with one presenting focal Super-refractory status-epilepticus.3 cases exhibited miliary tuberculomas extending into the spine, resulting in a bunch of grapes appearance in one.Atypical tuberculoma locations include facial colliculus, pituitary stalk, one abutting the hypothalamus causing hypersomnolence. 3) Ventricles-10 had ventriculitis, 3 had choroid plexitis, 2 had CP tuberculomas.

4) Vascular-24%(42) had CNS vasculitis, one had intracranial tubercular aneurysm with carotid web, one had sagittal sinus and vein of Galen thrombosis requiring decompression craniectomy due to malignant cerebral oedema

5) Posterior fossa-2 had giant tuberculoma in pons mimicking tumor, on biopsy revealed tuberculoma. Spinal manifestations include 8 Pott’s spine, 4 intramedullary tuberculomas, one each with LETM, peri-neuritis, cauda equina+ filum-Terminale meningitis and one with radiculo-myelitis secondary to mediastinal tuberculoma causing AFP. CONCLUSION:Considerable portion of cranial tuberculosis demonstrates a broad spectrum, causing delays. Knowledge of these atypical presentations is essential.

P Sindhura
BAI JERBAI WADIA HOSPITAL FOR CHILDREN
India

Payal shah
BAI JERBAI WADIA HOSPITAL FOR CHILDREN
India

Shilpa kulkarni
BAI JERBAI WADIA HOSPITAL FOR CHILDREN
India

FORAM GALA
BAI JERBAI WADIA HOSPITAL FOR CHILDREN
India

vrushabh gavali
BAI JERBAI WADIA HOSPITAL FOR CHILDREN
India