A starry sky can be beautiful – even in an emergency department of the hospital.
But instead of heavenly bodies that shine in the night, doctors stared in South Korea to clear brain injuries that scan a magnetic resonance (MRI). The resulting pattern, called a 'starry sky', meant that their 57-year-old patient had a dangerous form of tuberculosis. The doctors report the case in this week of the New England Journal of Medicine.
The man was previously treated for the infection in his lungs, but after two weeks of inexplicable headache, neck pain and tingling in his right hand at the hospital. The MRI and Computed -Tomography (CT) scans clearly revealed the problem: rare nodules and lumps, called tuberculomas, specks his lungs and central nervous system, including both cerebral hemispheres, the basal ganglia deep in the brain, the cerebellum on the back of the brain.
Magnetic resonance image formation (MRI) of the head with gadolinium improvement revealed countless small, spherical, peripheral improving lumps in the cerebral hemispheres (panels A and B), basal ganglia, cerebellum and brainstem, as well as in the upper backs of cm
Credit: NEJM, 2025
The condition, called CNS Tuberculoma, is a relatively rare manifestation of tuberculosis, which usually infects the lungs but every part of the body can invade. It is unclear exactly how tuberculomas form, but evidence suggests that the bacteria that cause tuberculosis –Mycobacterium tuberculosis –Can spread over the body through the blood. M. Tuberculosis Can get past the blood -brain barrier, possibly by hiding in a type of white blood cell called a macrophage, in a “Trojan horse” mechanism or by breaking through the barrier. It is thought that tuberculomas are formed when bacteria and macrophages sounded together in masses that can contain calcifications or cheese -like dead tissue, called Caseum.
