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Image Report

“Crown and necklace” appearance of cisternal tuberculoma

Department of Neurosurgery, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India.
Corresponding author: Ahmed Ansari, Department of Neurosurgery, Uttar Pradesh University of Medical Sciences, Saifai, Etawah - 206130, Uttar Pradesh, India.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Ansari A. “Crown and necklace” appearance of cisternal tuberculoma. Surg Neurol Int 2020;11:135.

We report a case of a 35-year-old female with features of headache and evening rise of temperature. She was found neurologically intact on examination. Contrast-enhanced MRI brain (axial and coronal) [Figures 1 and 2] showed multiple ring-enhancing lesions in the suprasellar and interpeduncular cisterns (crown appearance), and ambient and perimesencephalic cisterns (necklace appearance). Blood counts suggested a rise in lymphocytes with positive gamma interferon for tuberculosis. The patient was advised antitubercular treatment and was lost in follow-up after 3 months.

Figure 1:: Axial magnetic resonance imaging showing ring-enhancing lesions in cisterns giving “crown and necklace” appearance.
Figure 2:: Coronal magnetic resonance imaging with multiple tuberculomas in suprasellar cisterns.

Declaration of patient consent

Patient’s consent not required as patients identity is not disclosed or compromised.

Financial support and sponsorship

Publication of this article was made possible by the James I. and Carolyn R. Ausman Educational Foundation.

Conflicts of interest

There are no conflicts of interest.

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