Relevance and challenges of neuroimaging for childhood tuberculous meningitis diagnosis in a resource-constraint country: A case report and literature review

Objective: Tuberculous meningitis (TBM) may be an undiagnosed cause of childhood mortality or neurologic sequelae. Cranial computed tomography (CT) scan remains a relevant diagnostic and prognostic tool amidst negative cerebrospinal fluid or sputum findings for tuberculous meningitis (TBM) diagnosis. Delays in diagnosis and treatment increase morbidity in resource-constraint countries. Case report: A seven-year-old boy was referred with three weeks history of fever, progressive body weakness, aphasia and unconsciousness (three days). He had right cranial nerve III palsy, generalized hypertonia, and hyperreflexia in right lower limbs. All tuberculosis tests were negative except the cranial CT findings of leptomeningeal enhancement with basilar involvement and evidence of obstructive hydrocephalus. He was managed with anti-tuberculous drugs, prednisolone, ventriculoperitoneal shunt, and physiotherapy, and made a significant recovery after a year of anti-tuberculosis  treatment. Conclusion: The cranial CT scan findings facilitate TBM diagnosis for which prompt treatment commencement is crucial for a good outcome.