What causes recurrent fever, seizures, and elevated oxygen needs in a 12-year-old?

Question

Hello doctor,

I am asking for a 12-year-old girl who has been experiencing on-and-off fever for the past six months. A week ago, she had a sudden seizure attack and lost consciousness. She requires nearly 6 liters of oxygen via a mask, and her heart rate is elevated. Cerebrospinal fluid analysis revealed findings indicative of tuberculosis. Please help with interpreting the results of an MRI.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

According to the plain brain MRI (magnetic resonance imaging) report (attachments removed to protect the patient's identity) provided to me:

Hyperintensities (bright areas on MRI) are noted in the basal ganglia, internal capsule, and right parietal lobe with diffusion restriction (restriction to the diffusion of water protons). Such findings could suggest various processes affecting the brain, including:

Infections (bacterial, fungal, etc.).
Inflammatory conditions (viral).
Brain edema associated with diseases such as tuberculosis.
Tumors, etc.

Since this is a plain MRI, the list of differentials causing this type of picture on MRI could be extensive. A contrast MRI would be needed to narrow down the diagnosis. Intracranial manifestations of TB (tuberculosis) can range from meningitis and encephalitis to tuberculoma and abscess formation. Symptoms and signs include fever, seizures, focal neurological deficits, etc. (altered sensorium). Once again, a contrast MRI would help delineate these lesions. Treatment is based on an anti-tubercular treatment regimen.

I hope this information is helpful.

Take care.