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cns tuberculosis radiology

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Radiographics. 3 ). The disease predominantly involves the … Modern neuroimaging is the cornerstone in the early diagnosis of central nervous system (CNS) tuberculosis and may prevent unnecessary morbidity and mortality due to … The newer imaging techniques further help to improve the characterization and diagnosis of atypical CNS TB. Acta Radiol. Imaging plays an important role in the early diagnosis of CNS tuberculosis and may prevent unnecessary morbidity and mortality. MR imaging and spectroscopy of central nervous system infection. Tuberculosis (TB) is a global clinical concern, particularly after the human immunodeficiency virus pandemic. They reported that basal enhancement, tuberculomas, or both were 100% specific and 89% sensitive for the diagnosis of TBM. Middle cerebral and lenticulostriate arteries are the most common vessels involved. However, this terminology is used to describe all types of tuberculomas with en plaque morphology, including primary intraparenchymal lesions. Focal or diffuse cerebral atrophy and areas of encephalomalacia secondary to infarcts and hydrocephalus ( Fig. In contrast, TB pachymeningitis is rare and is characterized by thick plaque-like regions of pachymeningeal enhancement. MR imaging also plays an important role in the postoperative evaluation of patients with endoscopic third ventriculostomy. The imaging appearance has become more complex with the onset of multidrug-resistant tuberculosis. CT or MR angiogram reveal small segmental narrowing, uniform narrowing of large segments, irregular beaded appearance of vessels, or complete occlusion ( Fig. Dr. Mac For Radiology 2. These are termed Rich foci and form a reservoir from which intracranial manifestations may arise 5,7,8. Central nervous system tuberculosis takes various forms, including meningitis, tuberculoma, abscess, cerebritis, and miliary tuberculosis. Differential diagnosis of CNS TB includes multiple brain metastases (which associated with more edema); sarcoidosis (which are associated with parenchymal nodules and have multiple dural and/or leptomeningeal nodules, multifocal or multicentric primary tumour,and fungal infections. … This focus may be in the meninges, subpial or subependymal region of the brain, or the spinal cord. According to McGuinness, 74 the target sign, defined as a central nidus of calcification or central enhancement surrounded by a ring of enhancement, is a pathognomonic finding of central nervous system TB; however, recent studies have suggested that only the target sign with central calcifications is pathognomonic of tuberculoma, whereas the target sign with a central enhancing dot does not … Postcontrast T1W axial images (, Sequel of TB meningitis in 4 different patients. 6. However, similar imaging findings can be seen in various causes of inflammatory and noninflammatory conditions, especially meningioma. BACKGROUND AND PURPOSE: CNS tuberculosis may simulate other granulomas and meningitis on MR images. Localization of the cause of cranial nerve involvement, whether confined to the nerve or its brain stem nucleus, may help in prognostication of patients. It is no longer a disease confined to underdeveloped and developing countries. It is important to diagnose pachymeningeal TB because it responds well to antitubercular treatment and thus should be considered in the differential diagnosis of pachymeningeal abnormalities. Classic features of basal exudates, hydrocephalus, infarcts, and granulomas may not be seen in the elderly population, which has been attributed to age-related senescence of the immune system. Newer imaging techniques like magnetic resonance spectroscopy help to improve characterization and thus aid in diagnosis of atypical CNS TB. The central area of necrosis is initially solid and later may liquefy ( Fig. Ischemic infarcts are also a common complication, being seen in 20%40% of patients at CT (,Fig 10,), mostly within the b… Research IT. For further discussion, please refer to separate articles on intracranial tuberculoma. `Imaging `Bioppysy . CNS infection caused by Mycobacterium tuberculosis (TB) generally has a clinical presentation and imaging appearance different from that caused by typical bacteria. In addition, the type of hydrocephalus predicts the outcome of endoscopic third ventriculostomy. tuberculous otomastoiditis). This term should be reserved for cases where it is an isolated abnormality, and not confused with the sometimes dramatic thickening of dura adjacent to a tuberculoma 8. Manifestations include: The remainder of this article is a general discussion of CNS tuberculosis. METHODS: A total of 107 tuberculomas in seven patients with or without meningitis and 15 patients with tuberculosis meningitis alone were studied. However, multidrug-resistant tuberculosis remains a major hurdle in treatment. MR imaging, with its newer sequences, helps in differentiating the type of hydrocephalus and provides most details of brain and CSF pathways. Figure 1: gross pathology: tuberculous leptomeningitis, Case 5: calcified intracranial tuberculoma, Case 17: tuberculomas associated with ischemia, herpes simplex virus 1 (HSV-1) encephalitis, herpes simplex virus 2 (HSV-2) encephalitis, varicella zoster virus (VZV) encephalitis, HIV-associated neurocognitive disorders (HANDs), progressive multifocal leukoencephalopathy, Brownell-Oppenheimer variant of sporadic Creutzfeldt-Jakob disease, Heidenhain variant of sporadic Creutzfeldt-Jakob disease, acute necrotizing encephalopathy of childhood. Presentation material is for education purposes only. Tubercular Meningitis `Most common manifestation of CNS TB. They usually occur in the absence of TBM, but may occur with meningitis because of the extension of CSF infection into the adjacent parenchyma via cortical veins or Virchow-Robin spaces. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. `Considered disease of childhood however in India all age Considered disease of childhood , however in India all age groups susceptible . Specific magnetic resonance techniques, such as magnetization transfer imaging, proton magnetic resonance spectroscopy, diffusion, and perfusion imaging are useful in its characterization and management. It may account for ≈1/6th of the 3 million of global mortality due to Mycobacterium tuberculosis infection. 1999;75 (881): 133-40. others or those with possible infectious etiologies, hemorrhagic shock and encephalopathy syndrome ​, Intracranial manifestations of tuberculosis, Tuberculosis of the central nervous system. Tuberculosis of the joints is characteristically monoarticular; the knee and hip are most frequently affected. Tuberculous pachymeningitis can be localized or diffuse. Tuberculosis (TB) is a global clinical concern, particularly after the human immunodeficiency virus pandemic. The exudate in the basal cisterns can cause obstruction to cerebrospinal fluid (CSF) flow, causing hydrocephalus, and can compress cranial nerves. 11 ). CNS involvement is thought to occur in 2-5% of patients with tuberculosis and up to 15% of those with AIDS-related tuberculosis 6,7. CNS tuberculosis can manifest in a variety of forms, including tuberculous meningitis, tuberculomas, tuberculous abscesses, tuberculous cerebritis, and miliary tuberculosis. Leonard JM, Des prez RM. It occurs because of obstruction to CSF flow in the basal cisterns by inflammatory exudate ( Fig. British Journal of Nutrition; 106(2): 203-207; 2011. Cns tuberculoma 1. Less frequently, other mycobacteria may be involved. Springer Verlag. Central nervous system (CNS) tuberculosis is frequently encountered in tropical countries. Periventricular hypodensity on CT and periventricular hyperintense signal on proton density and T2-weighted (T2W) images on MR imaging indicate interstitial edema caused by periventricular ooze of CSF secondary to increase in intraventricular pressure. This article presents an extensive review of typical and atypical imaging appearances of intracranial tuberculosis, and discusses pathogenesis, patterns of involvement, and advances in imaging of intracranial tuberculosis. Lab Ware & Media Preparation. 3. Anterior distribution, particularly in the caudate nucleus and in the presence of multiple infarcts, favored a tuberculous cause, and posterior distribution indicated the possibility of associated risk factors of stroke. It subsequently develops a central area of caseating necrosis. The diagnosis is made by CSF sampling, but imaging findings may be suggestive. In contrast, others have reported no significant difference in the imaging appearances in these patients compared with immunocompetent patients. Eventually, mass-like regions of caseous necrosis can form within this exudate, representing extra-axial tuberculomas. 1. 13 ). The authors review the imaging characteristics of different forms of CNS tuberculosis involving the brain and spine and discuss the role of advanced imaging modalities in differentiating CNS TB from other disease process. Services A-Z. CNS tuberculosis usually results from hematogenous spread. Involvement of the central nervous system (CNS) is one of the most serious forms of this infection .Granulomatous inflammatory reaction in CNS caused by M. tuberculosis may involve the meninges, brain, spinal cord, and the bones A caseating granuloma is isointense to hypointense on both T1W and T2W images and shows isointense to hyperintense rim on T2W images. Pachymeningeal TB can occur as either isolated dural involvement ( Fig. There can be contiguous spread of infection from the adjacent bone. Not surprisingly CSF flow is disrupted, and obstructive hydrocephalus is common. In addition, MR imaging may not be readily available in resource-poor countries where TB is more common. Based on the observations of Rich and McCordock, a 2-step model has been proposed for the pathogenesis of CNS TB. Clinical presentation depends on the particular manifestation, although in all cases symptoms and signs are nonspecific and include fever, seizures, meningism and focal neurological deficits (e.g. The reported incidence of infarcts on CT varies from 20.5% to 38%. III. Kim TK, Chang KH, Kim CJ et-al. The probability of the organism reaching the brain depends on the extent of bacteremia and the immune response of the host. METHODS: A total of 107 tuberculomas in seven patients with or without meningitis and 15 patients with tuberculosis … AJNR Am J Neuroradiol. With greater prevalence immunocompromised patients, CNS involvement is seen in up to 15% of cases of acquired immunodeficiency syndrome – related tuberculosis. 8. The disadvantage of MR imaging is that the flow around the fourth ventricle may not easily be evaluated. Mycobacterium TB is responsible for almost all cases of tubercular infection in the central nervous system. Abnormal meningeal enhancement is seen in the basal cisterns, and sylvian fissures, and severe and late-stage TBM can show enhancement over the convexities ( Fig. 27 (5): 1255-73. Infect. Abstract Central nervous system (CNS) tuberculosis is a potentially life threatening condition which is curable if the correct diagnosis is made in the early stages. Most infarcts involve thalamus, basal ganglia, and internal capsule regions. Imaging Core Facility. 2 ). Tuberculomas arise when tubercles in the parenchyma of brain enlarge without rupturing into the subarachnoid space. Its clinical and radiologic manifestations may mimic other infectious and noninfectious neurological conditions. METHODS: A total of 107 tuberculomas in seven patients with or without meningitis and 15 patients with tuberculosis … Dis. Clinical and paraclinical manifestations of CNS TB may simulate other neurological diseases such as tumors and other infectious and noninfectious conditions. Khanna PC, Godinho S, Patkar DP et-al. Burrill J, Williams CJ, Bain G et-al. CNS involvement usually results from hematogenous spread. 4 ). North Am. Central nervous system (CNS) TB, the most dangerous form of extrapulmonary TB, can present as meningitis, intracranial tuberculomas, and abscesses. 1995;16 (9): 1903-8. Tuberculosis. 1 ). Gupta RK, Kathuria MK, Pradhan S. Magnetization transfer MR imaging in CNS tuberculosis. The conventional angiographic features of TBM include a triad of a hydrocephalic pattern, narrowing of arteries at the base of the brain, and narrowed or occluded small or medium-sized arteries with early draining veins. During the initial pulmonary infection, tuberculous bacteria may enter the systemic circulation and subsequently reach the oxygen-rich CNS, establishing a focus called the Rich focus. Imaging helps in early diagnosis and helps in preventing morbidity and mortality. Mild shortening of T1 and T2 relaxation times of CSF occurs as the disease progresses. The purpose of this study was to improve the characterization of lesions in CNS tuberculosis and to assess the disease load using magnetization transfer (MT) imaging. Cranial nerve involvement in TBM is seen in 17% to 70% of patients. Quantitative Genomics Facility. The lesions are hyperdense on noncontrast CT scans, isointense to brain on T1W MR imaging, and isointense to hypointense on T2W images with homogeneous postcontrast enhancement. It is believed that the bacilli reach the CNS by the haematogenous route secondary to disease elsewhere in the body. IT-Services. Cerebral infarction can occur because of obliterative vasculitis, the vessels at the base of the brain being severely affected. Central nervous system (CNS) tuberculosis is a potentially life threatening condition which is curable if the correct diagnosis is made in the early stages. Conley TB, Apolzan JA, Leidy HJ, Greaves KA, Lim E, and Campbell WW. Contrast-enhanced MR imaging is generally considered as the modality of choice in the detection and assessment of CNS tuberculosis. On MT imaging, abnormal meninges appearing hyperintense on precontrast T1-weighted (T1W) MT images is considered to strongly suggest tuberculous meningitis. 1. They can be solitary or multiple and can occur anywhere in the brain parenchyma. It has been shown that sensitivity has been improved when more than 1 criterion was present. Tuberculomas are among the most common intracranial mass lesions and the most common manifestation of parenchymal TB. Intracranial tuberculoma: MR imaging. • Greater prevalence in immunocompromised patients and is seen in ~ 15-20 % of cases of AIDS-related TB. Mycobacterium Tuberculosis Pulmonary tuberculosis Extra-pulmonary tuberculosis TB Lymphadenitis Pleural TB Skeletal TB (Bones & Joints) CNS TB – 1% of all Tuberculosis Abdominal TB Genitourinary TB Pericardial TB 3. Although diagnostic evaluation includes various microbiological, pathologic, molecular, and biochemical investigations, imaging modalities have an important diagnostic role. AJNR Am J Neuroradiol 1999;20: 867 ... – Central nervous system tuberculosis has different appearences, mostly hydrocephalus and tuberculomas. Introduction: Early diagnosis and treatment of central nervous system (CNS) tuberculosis (TB) are very important because of its high morbidity and … Andronikou and colleagues suggested 9 criteria for the diagnosis of TBM on computed tomography (CT). Postcontrast T1W axial (, Photomicrograph of tuberculous granuloma. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Imaging of extrapulmonary tuberculosis. Intracranial tuberculoma: comparison of MR with pathologic findings. Radiology reports should describe whether the radiograph shows entirely normal findings, shows calcified granulomas, shows fibronodular scarring (noting the duration of stability), or shows findings that raise concern for active tuberculosis. CNS involvement is thought to occur in 2-5% of patients with tuberculosis and up to 15% of those with AIDS-related tuberculosis 6,7. Early, accurate diagnosis can help in preventing morbidity and mortality. Neuroradiology. 7 ). Salgado P, Del brutto OH, Talamás O et-al. It also helps in differentiating tuberculous meningitis from other causes of meningitis. Granulomas may coalesce to form tuberculomas or, rarely, an abscess. Engin G, Acunaş B, Acunaş G et-al. 10 ). Tuberculous meningitis. BACKGROUND AND PURPOSE: CNS tuberculosis may simulate other granulomas and meningitis on MR images. Modern imaging is a cornerstone in the early diagnosis of CNS tuberculosis and may prevent unnecessary morbidity and mortality. It shows rim enhancement on postcontrast images ( Fig. Magnetic transfer (MT) MR imaging is an important technique and is considered superior to conventional MR imaging for showing abnormal meninges. Garg RK. On CT, solid noncaseating granuloma is isodense or slightly hypodense to the surrounding brain parenchyma. MR spectroscopy-aided differentiation: "giant" extra-axial tuberculoma masquerading as meningioma. Its clinical and radiologic manifestations may mimic other infectious and noninfectious neurological conditions. Radiograph/CT pneumoencephalography or contrast-enhanced cisternography done via lumbar puncture may help in differentiating communicating and noncommunicating hydrocephalus. Although CNS involvement by tuberculosis is seen in all age groups, there is a predilection for younger patients, with 60-70% of cases occurring in patients younger than 20 years of age 7. Tuberculomas show typical granulomatous reaction consisting of epithelioid cells, giant cells mixed with mononuclear inflammatory cells (predominantly lymphocytes) forming a noncaseating granuloma. sciCORE. Tuberculosis of the central nervous system. CLINICAL RADIOLOGY OF CEREBRAL TUBERCULOSIS Dr. Rahi kiran.B SR Neurology GMC, KOTA 2. • Approximately 10% of all patients with Tuberculosis have CNS involvement. 5. Presentation material is for education purposes only. Tentorial and cerebellar meningeal involvement is less common. Treatment of CNS tuberculosis is based on an anti-tubercular treatment regimen. Parenchymal tuberculous focus can develop into tuberculoma or brain abscess in the absence of adequate immunity or in the presence of a sizable tuberculous focus. Communications. Imaging cns tb 1. Minimal or absent meningeal enhancement has been reported in patients with acquired immune deficiency syndrome (AIDS) by some investigators, likely caused by the lack of immunologic response. They show homogeneous enhancement on post contrast scans ( Fig. Intracranial tuberculomas may occur either in isolation or combined with extra-axial TB infection. Neuroradiology. To discuss the imaging spectrum of CNS tuberculosis (TB meningitis and parenchymal TB) on CT and MRI 3. Severe cases may show leptomeningeal involvement over the cerebral convexities, and extension into the ventricular system can cause ependymitis and choroid plexitis. Identification of border zone encephalitis is difficult because the hyperintense T2 signal in these regions merges with the bright signal of the leptomeningeal exudate. It may account for ≈1/6 th of the 3 million of global mortality due to Mycobacterium tuberculosis infection. Parenchymal TB can occur in the form of tuberculoma, brain abscess, tuberculous encephalopathy, and tuberculous cerebritis. In endemic regions, tuberculomas account for as many as 50% of all intracranial masses 8. 1990;4 (4): 769-87. Tuberculomas can occur at any age. If there is evidence of TB elsewhere in the body, it may further suggest the diagnosis. Gupta R. Magnetization transfer MR imaging in central nervous system infections. Brain stem infarcts are less likely to show significant improvement, whereas the disorder confined to the nerve (neuritis/perineuritis) may improve with treatment. Clinical and paraclinical manifestations of CNS TB may simulate other neurological diseases such as tumors … In a known case of TB meningitis, contrast-enhanced CT scan (, Trapped ventricle: in a known case of TB meningitis with tuberculomas, MR scan reveals focal abnormal enhancement (, Complex hydrocephalus. • Greater prevalence in immunocompromised patients and is seen in ~ 15-20 % of cases of AIDS-related TB. The proximal portion of the nerve near its root entry is most commonly affected. Imaging plays an important role in its recognition and in its differentiation from other similar conditions. The brain parenchyma immediately adjacent to the inflammatory exudate shows edema, perivascular infiltration, and a microglial reaction, known as border zone reaction ( Fig. Unable to process the form. When the solid center liquefies, the center of the granuloma becomes hypodense on CT and hyperintense on T2W images with a peripheral hypointense rim and shows peripheral enhancement. For a general discussion on systemic tuberculosis, please refer to the article on tuberculosis. Miliary CNS tuberculosis, usually associated with tuberculous meningitis, pathogenetic relationship is suspected. Meningeal tuberculosis occurs when tuberculosis travels through the bloodstream to the membranes surrounding the brain and spinal cord, called the meninges. 35. The purpose of this study was to improve the characterization of lesions in CNS tuberculosis and to assess the disease load using magnetization transfer (MT) imaging. Imaging of CNS TB can be divided into types of involvement, as listed in Box 1 . Patients usually present with headache, seizures, focal neurologic deficit, and features of raised intracranial tension. Presence of tuberculomas at the corticomedullary junction suggests the hematogenous spread of infection, because there is narrowing of the arterioles at the gray/white matter junction. 11. Multiple large, pale histiocytes with plump cytoplasm are seen in the center. Hence, familiarity with the im … Pathogenesis of CNS tuberculosis Most tuberculous infections of the CNS are caused by Mycobacterium tuberculosis. Springer Us. The diagnosis is made by CSF sampling, but imaging findings may be suggestive. In a follow-up case of TB meningitis, T2W axial images show disproportionate enlargement of the left lateral ventricle (, TB vasculitis with acute infarct. With the onset of the human immunodeficiency virus pandemic, the incidence of tuberculosis, including central nervous system (CNS) tuberculosis, has increased in developed countries. Qualitative and quantitative information of CSF flow and dynamics can be obtained by MR imaging. This triad is specific for the diagnosis of TBM. Gupta RK, Gupta S, Singh D et-al. Central nervous system (CNS) tuberculosis occurs in approximately 1% of all patients with active tuberculosis. Later, this may rupture into the subarachnoid space or ventricular system leading to meningitis. In children, they predominate in the infratentorial compartment, whereas, in adults, the supratentorial compartment is more commonly affected. It results from the haematogenous dissemination of Myco-bacterium tuberculosis from primary pulmonary infection and the formation of small subpial and subependymal foci (Rich foci) in the brain and spinal cord.1 In some individuals Although mycobacterium tuberculosis can involve any organ, most commonly the lung, central nervous system (CNS) tuberculosis is the most devastating form of the disease. Central nervous system (CNS) tuberculosis (TB) is a dreadful form of TB which may be potentially lethal in the setting of delayed diagnosis. [] Clinical diagnosis can be difficult; therefore, imaging has an important role in establishing the diagnosis (see the images below). Kornienko VN, Pronin IN. Chest radiographs are important in the evaluation and risk stratification of patients suspected of having latent or inactive tuberculosis. 1989;31 (4): 299-302. pulmonary tuberculosis) or direct extension from local infection (e.g. Radiographics. Spinal infection may result in spondylitis, arachnoiditis, … Life Sciences Training Facility. The affected nerve shows thickening and enhancement on postcontrast images. Fibrotic changes in the late stage can cause permanent loss of function in these nerves. Meninges may be secondarily involved because of rupture of a tuberculoma into a vessel in the subarachnoid space, or rupture of miliary tubercles in miliary TB. (2009) ISBN:3540756523. Imaging, particularly magnetic resonance imaging, is a cornerstone in the diagnosis as well as follow-up of central nervous system (CNS) tuberculosis. Although CNS involvement by tuberculosis is seen in all age groups, there is a predilection for younger patients, with 60-70% of cases occurring in patients … Imaging appearance of CNS TB is becoming more and more complex and atypical with the onset of multidrug-resistant tuberculosis. • Approximately 10% of all patients with Tuberculosis have CNS involvement. Postgrad Med J. Central nervous system (CNS) tuberculosis is a potentially life threatening condition which is curable if the correct diagnosis is made in the early stages. According to the World Health Organization report, 1.3 million deaths were caused by TB in 2008, which is equivalent to 20 deaths per 10,000 population. Tuberculosis: a radiologic review. For further discussion please refer to separate articles on tuberculous leptomeningitis and tuberculous pachymeningitis. Brismar J, Hugosson C, Larsson SG et-al. Complications of meningitis include hydrocephalus, vasculitis, cranial nerve involvement, and associated multiple tuberculomas. The purpose of this study was to improve the characterization of lesions in CNS tuberculosis and to assess the disease load using magnetization transfer (MT) imaging. The epidemiology of patients with tuberculomas is the same as that of other CNS manifestations of tuberculosis (TB) (see CNS tuberculosis). Differential diagnosis of CNS TB includes multiple brain metastases (which associated with more edema); sarcoidosis (which are associated with parenchymal nodules and have multiple dural and/or leptomeningeal nodules, multifocal or multicentric primary tumour,and fungal infections. They may be associated with extensive adjacent leptomeningeal and/or pachymeningeal enhancement. CT cannot predict the level of CSF block in TBM because both types of hydrocephalus can present with panventricular dilatation. CNS Tuberculosis Involvement of CNS seen in approximately 5% of total patients of tuberculosis. Indian J Radiol Imaging 2002;12:51-8. Nair and colleagues described the MR imaging pattern of infarcts in TB. Kumar and colleagues found that the presence of basal enhancement, hydrocephalus, tuberculoma, and infarction were more common in TBM than in children with pyogenic meningitis. CLINICAL RADIOLOGY OF CEREBRAL TUBERCULOSIS Dr. Rahi kiran.B SR Neurology GMC, KOTA 2. They typically appear as ring-enhancing lesions with surrounding vasogenic edema. 1994;36 (2): 87-92. Store & Supply. A 37-year-old woman presented with headaches. CNS infection caused by Mycobacterium tuberculosis (TB) generally has a clinical presentation and imaging appearance different from that caused by typical bacteria. Imaging findings depend on the stage of tuberculoma, whether it is noncaseating or caseating with solid or liquid center. Workshops Direct mass effect of a tuberculoma on the nerve within the subarachnoid course or by direct involvement of the cranial nerve nuclei in the brain are the other mechanisms ( Fig. In the early stages, noncontrast MR imaging shows little or no evidence of meningitis. Thus, common imaging triad includes abnormal meningeal enhancement predominantly in the basal regions of brain and its associated complications of hydrocephalus and infarcts. MR imaging detects a greater number of infarcts and hemorrhagic transformation of infarcts than CT. Cell-mediated immunity is responsible for the formation of dense, gelatinous, inflammatory exudate along the basal surface of the cerebrum.

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