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Does Increased Leptomeningeal Activity Mean That The Brain TB Has Increased?
Question: Hello Doctor,
My mom has been suffering from lymph node and brain TB since 2015. She has been on TB medication since then. The lymph node TB has reduced but the brain TB is still there. Here are her last 4 brain MRI findings
July 2016: Patchy and leptomeningitis with extension. There is a moderate decrease in the size with complete resolution of perilesional odema
March 2017: Significant increase in the extent of the Leptomeningeal involvement
Nov 2017: Subtle Leptomeningeal enhancement
Significant Decrease in the extent of meningeal enhancement.
April 2018: Inview of increased Leptomeningeal, hypothalamic, pituitary, diffuse dural involvement.
Can you please answer my below questions
(1) Does increased leptomeningeal activity mean that the brain TB has increased?
(2) In the Nov 2017 MRI scan it says Subtle Leptomeningeal enhancement and Significant Decrease in the extent of meningeal enhancement. In the latest scan it doesn't talk anything about meningeal enhancement, doest that mean that it has been cured?
(3) What is the difference between Leptomeningeal enhancement and meningeal enhancement? Is it the same, are they both related to TB?
Please let me know. Thank You.
My mom has been suffering from lymph node and brain TB since 2015. She has been on TB medication since then. The lymph node TB has reduced but the brain TB is still there. Here are her last 4 brain MRI findings
July 2016: Patchy and leptomeningitis with extension. There is a moderate decrease in the size with complete resolution of perilesional odema
March 2017: Significant increase in the extent of the Leptomeningeal involvement
Nov 2017: Subtle Leptomeningeal enhancement
Significant Decrease in the extent of meningeal enhancement.
April 2018: Inview of increased Leptomeningeal, hypothalamic, pituitary, diffuse dural involvement.
Can you please answer my below questions
(1) Does increased leptomeningeal activity mean that the brain TB has increased?
(2) In the Nov 2017 MRI scan it says Subtle Leptomeningeal enhancement and Significant Decrease in the extent of meningeal enhancement. In the latest scan it doesn't talk anything about meningeal enhancement, doest that mean that it has been cured?
(3) What is the difference between Leptomeningeal enhancement and meningeal enhancement? Is it the same, are they both related to TB?
Please let me know. Thank You.
Brief Answer:
Increased meningeal enhancement means more active TB
Detailed Answer:
Thank you for posting your query.
I am Dr Sudhir Kumar, Neurologist, and I would try my best to help you.
I have noted your mother's clinical and MRI brain details. My replies to your queries are below:
1. Yes, increased leptomeningeal activity means that the brain TB has increased.
2. Latest scan also talks of leptomeningeal enhancement, which means that TB is still active.
3. Leptomeningeal and meningeal mean the same (they refer to the coverings of brain- the meninges). There are three layers of brain coverings- namely, dura mater, pia mater and arachnoid mater. In TB, there is involvement and inflammation of these meninges, which is referred to as meningeal or leptomeningeal enhancement on MRI or CT scan of brain.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Increased meningeal enhancement means more active TB
Detailed Answer:
Thank you for posting your query.
I am Dr Sudhir Kumar, Neurologist, and I would try my best to help you.
I have noted your mother's clinical and MRI brain details. My replies to your queries are below:
1. Yes, increased leptomeningeal activity means that the brain TB has increased.
2. Latest scan also talks of leptomeningeal enhancement, which means that TB is still active.
3. Leptomeningeal and meningeal mean the same (they refer to the coverings of brain- the meninges). There are three layers of brain coverings- namely, dura mater, pia mater and arachnoid mater. In TB, there is involvement and inflammation of these meninges, which is referred to as meningeal or leptomeningeal enhancement on MRI or CT scan of brain.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank You for your response Dr. XXXXXXX I have a couple of follow up questions
(1) Since leptomeningeal and meningeal are different layers of the brain, does that mean the TB in the meningeal layer has reduced but it has not reduced in the Leptomeningeal layer. My mom however is very active and does all the work, goes out - without any trouble
(2) She has been on TB medication for over 2 n half years and since the TB bacteria has not reduced, what are our other diagnosis and treatment options?
Please let me know. Thank You
Brief Answer:
We need to think of MDR TB
Detailed Answer:
Thank you for getting back.
1. I think I was not clear. As you see in my previous reply (point 3), meningeal and leptomeningeal are SAME. So, there is still active TB, if enhancement is noted in meninges (leptomeningeal or meningeal) on the MRI scan.
2. Generally, brain TB gets cured in 18 months. If TB is not cured within that period, we need to think of multi-drug resistant TB (MDR TB) and second line anti-TB drugs are needed for that category.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
We need to think of MDR TB
Detailed Answer:
Thank you for getting back.
1. I think I was not clear. As you see in my previous reply (point 3), meningeal and leptomeningeal are SAME. So, there is still active TB, if enhancement is noted in meninges (leptomeningeal or meningeal) on the MRI scan.
2. Generally, brain TB gets cured in 18 months. If TB is not cured within that period, we need to think of multi-drug resistant TB (MDR TB) and second line anti-TB drugs are needed for that category.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank You again Doctor.
We had tested her for Multi Drug Resistant TB 2 years back by taking a sample from her lymph node (at that point she had Lymph node TB as well which was cured) and the reports said that she had NO MDR TB.
(1) Should we get her tested for MDR TB again?
(2) If yes, how and from where do we take a sample?
Thank You.
Brief Answer:
Unfortunately, there is NO confirmatory test for MDR TB.
Detailed Answer:
Thank you for getting back.
There is no confirmatory test for proving MDR TB. This is because TB bacteria most often do not grow in cultures.
Therefore, lack of improvement with first line TB drugs even after 18 months can be taken as an evidence that it could be MDR TB.
I suggest you to speak to her doctor and decide about starting second line Anti TB drugs.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Unfortunately, there is NO confirmatory test for MDR TB.
Detailed Answer:
Thank you for getting back.
There is no confirmatory test for proving MDR TB. This is because TB bacteria most often do not grow in cultures.
Therefore, lack of improvement with first line TB drugs even after 18 months can be taken as an evidence that it could be MDR TB.
I suggest you to speak to her doctor and decide about starting second line Anti TB drugs.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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