This patient had miliary TB with a secondary tuberculoma of the scalp with trans-calvarial spread to the meninges and subsequently produced multi-focal cortical cerebritis. Tuberculous meningitis classically involves the basilar cisterns (although not seen here) producing intense meningeal enhancement as well as "popcorn" calcifications in the basilar cisterns. Tuberculous meningitis like other chronic meningitides may be complicated by infarction of the basal ganglia and thalami from involvement of the lenticulostriate and thalamoperforating arteries. Focal cerebritis (as in this case) leading to frank abscess are also complications. Other forms of chronic meningitis to consider are coccidioidomycosis and cryptococcus. Metastatic disease is another consideration. Related Cases
