NEUROIMAGES Tuberculous meningovasculitis Figure MRI and angiography Fluid-attenuated inversion recovery (FLAIR) MRI shows left-sided subcortical hyperintensities consistent with infarction (A). Abnormal enhancement of basal cisterns (B, arrowheads), sylvian fissures (B, arrows), and optic nerves (C, arrows) can be seen on contrastenhanced T1-weighted imaging. Angiography demonstrates multifocal areas of arterial narrowing at the base of the brain (D). A 49-year-old woman presented with subacute onset of headache, vomiting, confusion, visual disturbances, and speech difficulty. Clinical examination revealed mild global aphasia and altered visual acuity. Brain MRI showed white matter abnormalities in the left hemisphere, and abnormal gadolinium enhancement of basal cisterns, sylvian fissures, and optic nerves (figure). CSF examination showed 60 lymphocytes/mm3, increased protein content of 1 g/L, and reduced glucose level of 0.26 g/L (blood glucose level of 1.09 g/L). Angiography revealed multifocal narrowing of arteries at the base of the brain (figure). Three weeks later, Mycobacterium tuberculosis was cultured from CSF. A diagnosis of tuberculous meningovasculitis was made.1,2 Dimitri Renard, MD; Raul Morales, MD; and Chérif Heroum, MD, Montpellier, France Disclosure: The authors report no conflicts of interest. Address correspondence and reprint requests to Dr. Dimitri Renard, Department of Neurology, CHU Montpellier, Hôpital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier, France; dimitrirenard@hotmail.com REFERENCES 1. Morgado C, Ruivo N. Imaging meningo-encephalic tuberculosis. Eur J Radiol 2005;55:188–192. 2. Bernaerts A, Vanhoenacker FM, Parizel PM, et al. Tuberculosis of the central nervous system: overview of neuroradiological findings. Eur Radiol 2003;13:1876–1890. Copyright © 2007 by AAN Enterprises, Inc. 1745 Tuberculous meningovasculitis Dimitri Renard, Raul Morales and Chérif Heroum Neurology 2007;68;1745 DOI 10.1212/01.wnl.0000263653.20798.09 This information is current as of May 14, 2007 Updated Information & Services including high resolution figures, can be found at: http://www.neurology.org/content/68/20/1745.full.html References This article cites 2 articles, 0 of which you can access for free at: http://www.neurology.org/content/68/20/1745.full.html##ref-list-1 Citations This article has been cited by 2 HighWire-hosted articles: http://www.neurology.org/content/68/20/1745.full.html##otherarticles Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): All Infections http://www.neurology.org//cgi/collection/all_infections Bacterial infections http://www.neurology.org//cgi/collection/bacterial_infections MRI http://www.neurology.org//cgi/collection/mri Optic nerve http://www.neurology.org//cgi/collection/optic_nerve Permissions & Licensing Information about reproducing this article in parts (figures,tables) or in its entirety can be found online at: http://www.neurology.org/misc/about.xhtml#permissions Reprints Information about ordering reprints can be found online: http://www.neurology.org/misc/addir.xhtml#reprintsus Neurology ® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright . All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.