What’s a picture worth?

In the world of TB, Tai et al.1 assessed the sensitivity and specificity of brain MRI for diagnosing CNS tuberculosis in Malaysia. They compared imaging in patients presenting with a meningoencephalitis who had TB confirmed by cerebrospinal fluid studies (PCR or AFB) and/or by tissue examination at autopsy to the MRI findings of patients with meningoencephalitis but not TB looking for what they termed “classical” TB imaging abnormalities which included—

  • Basilar enhancement
  • Hydrocephalus
  • Basal ganglia or thalamic infarcts
  • Tuberculomas
  • Vasculitis/vasospasm evident on MRA

They found that 89% of people with TBM had ≥ 1 classical MRI finding compared to only 4% of patients with other meningoencephalitides. Their study population was largely HIV uninfected (only 7% HIV positive). There would be significant value to determining if the excellent sensitivity and specificity of imaging in this population holds true for people with HIV.

  1. Tai MS, Mohn Nor, H., Rahmat, K., Viswanathan, S., Abdul Kadir, A., Ramli, N., Abu Bakar, F.K., Mohd Zain, N.R., Abdullak, S., Yap, J.F., Shaheed, J., Ng, B.S., Rafia, M.H., Tan, C.T. Neuroimaging findings are sensitive and specific in diagnosis of tuberculous meningitis. Neurology Asia 2017; 22(1): 15-23.


Gretchen L. Birbeck, MD, MPH

Gretchen L. Birbeck, MD, MPH

Gretchen Birbeck is a neurologist who divides her time between the US and Africa. Her US academic home is the University of Rochester where she is the Rykenboer Professor of Neurology and Research Director for the Strong Epilepsy Center with adjunct appointments in the Center for Human Experimental Therapeutics and the Department of Public Health. Her additional skills in epidemiology, health services research, and tropical medicine are brought to bear during the 6-months annually she spends in Africa where she serves as Director for the Chikankata Epilepsy Care Team in rural Mazabuka, Zambia, an Honorary Lecturer at the University of Zambia and a consultant for the Paediatric Research Ward at Queen Elizabeth Central Hospital in Blantyre, Malawi. Gretchen’s research programs are aimed at identifying opportunities to prevent or ameliorate the medical and social morbidities of common neurologic conditions in low-income, tropical settings with the ultimate goal of developing successful interventions feasible for scale up and broad implementation. She has been recognized as an Ambassador for Epilepsy by the International League against Epilepsy, a Global Health Research Ambassador by the US Paul Rogers Society, a National Outreach Scholar by the WK Kellogg Foundation and a Leader in Medicine by the American Medical Students Association.

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