TBM is associated with high mortality and morbidity. In many cases, microbiological evidence is lacking, making clinical and radiological findings critical for diagnosis. We collected radiological data from TBM patients at two high-burden centres in India.

Data was collected from TBM patients admitted at PGIMER, Chandigarh, and AIIMS, New Delhi between 2019 and 2023. CT, MRI of the brain, and MRAngiogram (MRA) performed at admission were reviewed by neuroradiology experts at each centre.

We enrolled a total of 237 patients. TBM Diagnosis was definite in 122 patients (51%), highly probable in 96 (41%), and probable in 19 (8%) based on Modified Ahuja's criteria.

CT head and MRI were performed for 215 (91%) and 229 (96.6%) patients, respectively, and the latter revealed hydrocephalus in 136 (57.3%), exudates in 170 (72%), tuberculomas in 105 (44%), and infarctions in 72 (31%). Infarcts were located in the cortical (12.2%), subcortical (15.2%), basal ganglia (22.4%), brainstem (12.2%), and cerebellum (4.24%) regions. MRA was done in 207 patients (87.7%), detecting occlusions in 52 (22%), primarily in the MCA territory (M1,19.4%; M2,10.5%) followed by ACA(13.5%), PCA(7.2%) and BA(1.7%). Mortality at 3 months was 13%, and 116 patients (49.1%) had a favourable functional outcome (mRS ≤ 2).

Regression analysis showed that occlusion in the M1 and M2 segments of the MCA was significantly associated with an increased risk of mortality at 3months.

This study highlights the significant role of neuroimaging, particularly MRI and MRA, in TBM diagnosis and prognosis. Mortality at 3 months was significantly associated with arterial occlusions in the M1 and M2 segments of the MCA.  Early detection of these vascular changes is crucial for improving outcomes in TBM patients.