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Medicine Hydrocephalus Biopsy Chemotherapy Meningitis Pathology Brain biopsy Communicating hydrocephalus Tuberculous meningitis Radiology Surgery

Martha Hickey , Myra S. Hunter , Nanette Santoro , Jane M. Ussher ·

YOU? · · 2022 · Open Access · · DOI: https://doi.org/10.1136/bmj-2021-069369 · OA: W4282975457

Three patients are reported on who presented with communicating hydrocephalus due to presumed tuberculous meningitis. Subsequent clinical deterioration despite antituberculous chemotherapy prompted reassessment with FDG-PET scanning and meningeal biopsy in one case and repeat CSF cytology with special staining in the second. The third patient died and postmortem confirmed a diagnosis of primary diffuse leptomeningeal gliomatosis. In the first two patients, MRI of the entire neuraxis showed no evidence of a primary intraparenchymal tumour. These cases emphasise the need for repeated reassessment in patients with culture negative lymphocytic meningitis. In addition, this is the first report of FDG-PET scanning in leptomeningeal gliomatosis.