45 year old man with pulmonary tuberculosis was admitted for headache, malaise, mental confusion and vomiting. He had progressive neurologic deficits over some time.
CSF analysis showed mononuclear cells, some neutrophils, elevated protein concentration and moderately reduced glucose
The subarachnoid space shows a fibrinous exudate involving the leptomeninges at the base of the brain, effacing the cisterns and encasing the cranial nerves. Arachnoid fibrosis has set in producing internal hydrocephalus
The dash line demonstrate the position of the MR slice