Intracranial tuberculoma

Intracranial tuberculomas are one of the common causes of space-occupying lesions of the brain in developing countries 1).


Intracranial tuberculoma is an uncommon presentation of tuberculosis, and its occurrence in an intraventricular location is very rare. It is usually confused with glioma, parasitic cyst, and craniopharyngioma. Few case reports exist in the literature on this entity.

The combination of spinal intramedullary tuberculosis and intracranial tuberculomas is extremely rare and only few cases have been reported in the literature so far 2) 3) 4) 5) 6).

A young woman who complained of visual acuity decreased in the right eye for 12 days visited the Department of Ophthalmology. A solitary and occupancy lesion was seen in the posterior pole of the fundus of the patient's right eye, accompanied by intracranial and pulmonary tuberculosis. The diagnosis was choroidal tuberculoma, intracranial tuberculoma, and invasive pulmonary tuberculosis. After anti-tuberculosis treatment, the lesions of lung were better, but the lesions in the right eye and brain were paradoxical worsening. Finally, the lesion was calcification and absorption after combined glucocorticoid therapy 7)


A case of tuberculoma mimicking a high grade glial tumor on magnetic resonance imaging and clinical presentation. A 30-year-old woman presented with one-month history of epilepsy. Cranial magnetic resonance imaging showed a left occipital peripheral ring-enhanced lesion with central necrosis. There was a strong suspicion of glial tumor. The lesion was totally excised with left occipital craniotomy. Histological examination of mass revealed a tuberculoma. The patient was treated with antituberculous chemotherapy 8)


1)
Jayakumar PN, Nagarajan K. Alkaline pH in intracranial tuberculomas: A 31Phosphorus magnetic resonance spectroscopy study. J Neurosci Rural Pract. 2022 Oct-Dec;13(4):791-794. doi: 10.25259/JNRP-2022-6-25. Epub 2022 Dec 2. PMID: 36743769; PMCID: PMC9894005.
2)
Huang CR, Lui CC, Chang WN, Wu HS, Chen HJ. Neuroimages of disseminated neurotuberculosis: Report of one case. Clin Imaging. 1999;23:218–22.
3)
Lin SK, Wu T, Wai YY. Intramedullary spinal tuberculomas during treatment of tuberculous meningitis. Clin Neurol Neurosurg. 1994;96:71–8.
4)
Shen WC, Cheng TY, Lee SK, Ho YJ, Lee KR. Disseminated tuberculomas in spinal cord and brain demonstrated by MRI with gadolinium-DTPA. Neuroradiology. 1993;35:213–5.
5)
Thacker MM, Puri AI. Concurrent intra-medullary and intra-cranial tuberculomas. J Postgrad Med. 2004;50:107–9.
6)
Yen HL, Lee RJ, Lin JW, Chen HJ. Multiple tuberculomas in the brain and spinal cord: A case report. Spine (Phila Pa 1976) 2003;28:E499–502.
7)
Hu JY, Du N, Bao YH, Zhang WF. [Paradoxical worsening after treatment of choroidal tuberculoma: a case report]. Zhonghua Yan Ke Za Zhi. 2023 Mar 11;59(3):213-216. Chinese. doi: 10.3760/cma.j.cn112142-20220810-00392. PMID: 36860109.
8)
Suslu HT, Bozbuga M, Bayindir C. Cerebral tuberculoma mimicking high grade glial tumor. Turk Neurosurg. 2011;21(3):427-9. doi: 10.5137/1019-5149.JTN.2947-10.0. PMID: 21845585.
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