Presentation
Headache, disorder of consciousness, and focal epileptic seizure.
Patient Data
NCCT: multiple areas of vasogenic edema mainly affecting the right hemisphere, compromising the fontal, temporal, and parietal lobes, causing a slight midline shift; hypoattenuation in the midbrain with effacement of the ambiens cistern; and a decrease in the size of the fourth ventricle.
C+ CT: multiple confluent brain lesions with solid nodular contrast enhancement in the cerebral hemispheres, brainstem, and cerebellum, as well as diffuse leptomeningeal contrast enhancement.
Chest x-ray: widespread distributed nodules of ~2 mm in both lungs.
Case Discussion
The majority of patients with miliary tuberculosis have involvement of the nervous system due to dissemination through the circulatory system.
The patient underwent specific TB treatment and high doses of steroids, resulting in considerable improvement in motor function and level of consciousness.
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