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Volume 6, Issue 3, Pages 230-236 (March 2007) Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study Dr Guy E Thwaites, MRCP, Jeremy Macmullen-Price, FRCR, Tran Thi Hong Chau, MD, Pham Phuong Mai, MD, Nguyen Thi Dung, MD, Cameron P Simmons, PhD, Nicholas J White, FRCP, Tran Tinh Hien, MD, David Summers, FRCR, Jeremy J Farrar, FRCP The Lancet Neurology Volume 6, Issue 3, Pages 230-236 (March 2007) DOI: 10.1016/S1474-4422(07)70034-0 Copyright © 2007 Elsevier Ltd Terms and Conditions

Figure 1 Common MRI findings in adults with tuberculous meningitis A: Contrast enhanced axial T1-weighted image reveals thick leptomeningeal enhancement in suprasellar cistern extending into sylvian fissures and ambient cisterns. Temporal horns are also dilated. B: Contrast enhanced axial T1-weighted image reveals leptomeningeal enhancement within cortical sulci and sylvian fissures. Diffuse low signal around sylvian fissures suggests oedematous change. C: Axial T1-weighted image reveals hydrocephalus with dilated lateral and third ventricles. D: Sagittal T1-weighted image following intravenous contrast administration. There is prominent enhancement in the pituitary fossa and along the hypothalamus. The aqueduct of sylvius is clearly patent and third ventricle is dilated. E: Contrast enhanced coronal T1-weighted image. Multiple enhancing nodules, principally parenchymal but also ependymal and leptomeningeal. F: Contrast enhanced coronal T1-weighted image. Marked basal and right sylvian fissure leptomeningeal enhancement is present. Lateral ventricles are dilated. G: Enhanced axial T1-weighted image. There is a large nodular focus of enhancement within the left sylvian fissure extending into the left temporal lobe associated with substantial low-signal change. H: Axial T2-weighted image reveals extensive high signal within left cerebral hemisphere with large heterogeneous signal tuberculoma in sylvian fissure. I: Gadolinium-enhanced T1 coronal imaging showing extensive basal meningeal enhancement and established left capsulostriate lacunar infarct. The Lancet Neurology 2007 6, 230-236DOI: (10.1016/S1474-4422(07)70034-0) Copyright © 2007 Elsevier Ltd Terms and Conditions

Figure 2 Effect of dexamethasone on MRI appearances of tuberculous meningitis during treatment Proportions of patients with post-contrast enhancement (A), cerebral infarcts (B), tuberculomas (C), and hydrocephalus (D) before and after treatment with dexamethasone (blue bars) or placebo (red bars). The Lancet Neurology 2007 6, 230-236DOI: (10.1016/S1474-4422(07)70034-0) Copyright © 2007 Elsevier Ltd Terms and Conditions