A 72-year-old previously healthy man with a medical history of hypertension was hospitalized with fever and confusion. Chest computed tomography (CT) images revealed diffuse granules in the lungs, suggesting miliary tuberculosis. Cerebrospinal fluid (CSF) analysis showed elevated levels of cell count (58 /mul), protein (374 mg/dl), and adenosine deaminase (17 U/L), with low glucose levels (32 mg/dl; serum glucose level at 169 mg/dl). Culture and PCR testing for Mycobacterium tuberculosis in the CSF provided negative results, while sputum testing showed positivity. Contrast-enhanced magnetic resonance imaging (MRI) revealed meningeal enhancement from the basilar portion of the cerebrum to the sylvian fissure and multiple infarctions (Figure 1 ). The patient was diagnosed with miliary tuberculosis and tuberculous meningitis (TBM), was administered antituberculosis agents along with systemic corticosteroid therapy, and finally survived with dysphagia and dysarthria as sequelae.
TBM is complicated with multiple infarctions and basilar meningitis, resulting in high mortality and neurologic sequelae. The typical findings of TBM in MRI are meningeal enhancement, particularly at the basilar meninges and the sylvian fissure, and vasculitis-related infarction at the circle of Willis. TBM should be listed as a differential diagnosis for patients with disturbed consciousness, for which MRI should be performed.