| Intracranial tuberculomas manifesting radiologically as typical dural-based "meningiomas" have been reported, most frequently in immunosuppressed patients. Their incidence is high in developing countries; they are only sporadically observed in Western europe and north america, usually in patients with acquired immunodeficiency syndrome (AIDS). According to published reports, intracranial tuberculomas are always due to infection by mycobacterium tuberculosis. We report a case of a 50-year-old woman with systemic lupus erythematosus (SLE) who presented with a dural based, meningioma-like mass in the right frontal region, resulting from a localized infection by mycobacterium avium complex. Histologically, the mass resembled a meningioma in being composed of spindly cells arranged in a fascicular pattern. Immunohistochemical stains showed this tumor to consist of a large aggregate of AFB-laden histiocytes without caseating necrosis or multinucleated giant cells. ( info) |
12/114. Cranial epidural tuberculoma. A case report. A 33-year-old patient with cranial epidural tuberculoma without history of tuberculosis is described. CT and MR imaging showed a lesion located on both sides of a right frontotemporal bone destruction with epidural extent. Except for a small necrotic core, the lesion enhanced intensely after contrast medium administration. osteitis and subgaleal abscess were associated. The displaced dura mater delineated the epidural tuberculoma. diagnosis was verified by histology and identification of mycobacterium tuberculosis. After removal of the tuberculoma and combination therapy, there was a complete regression of abnormalities. Differential diagnoses are dural tuberculoma, focal tuberculous pachymeningitis and tuberculous epidural empyema. ( info) |
13/114. neurocysticercosis like presentation in a case of CNS tuberculosis. A clinical picture consisting of seizures, multiple non-tender subcutaneous nodules, and multiple 'nodular or ring' enhancing lesions in computed tomography of the brain is considered characteristic of neurocysticercosis in an endemic area. 1,2 A case with a similar clinical picture, in whom serological tests and histopathological examination of subcutaneous nodule established tuberculosis as a cause, is presented. ( info) |
14/114. Case report: one-and-a-half-syndrome and tuberculosis of the pons in a patient with AIDS. A patient with advanced AIDS presented with right conjugate gaze palsy and impaired adduction on left gaze (the one-and-a-half syndrome). The responsible pontine lesion involved the ipsilateral abducens nucleus and the adjacent medial longitudinal fasiculus (MLF), as demonstrated by magnetic resonance imaging (MRI). Tuberculosis (TB) was the etiology of the brainstem lesion. The patient had complete recovery after anti-tuberculosis treatment. The nuclear location of the tuberculoma is unusual and the reversal of this neuro-ophthalmologic syndrome is noteworthy. ( info) |
15/114. Composite pituitary adenoma and intrasellar tuberculoma: report of a rare case. Tuberculous involvement of the pituitary gland is rare. We report a unique case of a composite lesion consisting of pituitary adenoma and intrasellar tuberculoma. A 24-year-old lady presented with features of acromegaly and amenorrhea. serum growth hormone levels were found to be raised. Radiological investigations were consistent with a pituitary adenoma. decompression of the lesion was done through trans-sphenoidal approach. Histological examination revealed a growth hormone secreting pituitary adenoma in association with a granulomatous lesion suggesting of pituitary tuberculoma. No other evidence of tuberculosis was found in the brain or spinal cord. This type of dual pathology has been reported only once in the earlier literature. ( info) |
16/114. Possible role of adjunctive thalidomide therapy in the resolution of a massive intracranial tuberculous abscess. We present the case of a young child who developed a massive tuberculous abscess of the posterior fossa while being treated for pulmonary tuberculosis. Clinical improvement after surgical excision of the abscess was followed by recurrence of symptoms of acutely raised intracranial pressure on standard antituberculosis and corticosteroid therapy. Magnetic resonance (MR) imaging of the brain showed that a multiloculated abscess had developed anterior to the excision site of the original abscess. The recurring abscess was partly excised and drained but could not be removed completely because of its proximity to the brain stem. thalidomide, a potent inhibitor of tumour necrosis factor alpha (TNF-alpha), was added to the treatment regimen and resulted in marked clinical improvement with resolution of the abscess within 4 months. The remaining CT lesion had the appearance of a small granuloma. Both the clinical and the radiological response was maintained after 1 year of antituberculosis treatment. ( info) |
17/114. Focal limb dystonia in a patient with a cerebellar mass. BACKGROUND: Focal dystonia of acute onset is indicative of a structural lesion in the nervous system. Cerebellar lesions have rarely been associated with dystonia. CASE DESCRIPTION: A 42-year-old woman was admitted to the neurology ward because of fever, confusion, and gait unsteadiness. She was diagnosed as having tuberculous meningitis, and, after a few days of antituberculous treatment, she developed prominent dystonia of the left upper limb. Cranial nuclear magnetic resonance imaging showed an isolated lesion compatible with a tuberculoma in the left cerebellar hemisphere. Both the limb dystonia and the tuberculoma resolved with maintained antituberculous treatment. CONCLUSIONS: In the patient described, the presence of upper-limb dystonia ipsilateral to a focal cerebellar lesion and the resolution of the dystonia and the mass lesion following treatment suggest that the cerebellum or its connections to the thalamus and/or basal ganglia could be involved in the pathophysiology of the dystonia. ( info) |
18/114. cavernous sinus tuberculoma: diagnostic difficulties in a personal case. BACKGROUND: tuberculoma of the brain is rare, and its location in the cavernous sinus is exceptional. Many factors make the diagnosis difficult, necessitating a surgical procedure. CASE DESCRIPTION: A 44-year-old woman complained of persistent headaches and diplopia. The examination revealed a right cavernous sinus syndrome. Radiologic investigation showed a growing process in the right cavernous sinus, overlapping the sella turcica. The diagnoses of metastasis, tuberculoma, and sarcoidosis were considered, but none of them could be confirmed. A biopsy of the lesion via a subtemporal approach revealed a tuberculoma. Antituberculous treatment led to complete resolution of her symptoms. CONCLUSION: The diagnosis of a cavernous sinus tuberculoma is difficult; it is confirmed by biopsy. However, a trial of medical treatment, if the results are favorable, may obviate the need for a surgical procedure. ( info) |
| Six patients with cerebral tuberculoma seen over a 2 year period are reported. Their clinical presentations, the result of investigations including radiological findings and their response to medical treatment are discussed and correlated with other reports in the literature. Eighty five percent of the patients were above the age of 30 years. All patients had negative past history of tuberculosis and both chest x-ray and erythrocyte sedimentation rate were within normal limits. Five patients presented with symptoms and signs of space occupying lesions but none had papilloedema. Two patients showed paradoxical enlargement or development of new tuberculous lesions during antituberculous therapy. The diagnosis was established by brain magnetic resonance imaging in 3 patients, and was further confirmed by brain biopsy in the other 3. All patients received antituberculous treatment for 12 months, except one who continued medication for 2 years. Four patients normalized with medical treatment. Intracranial tuberculoma must be included in the differential diagnosis of a space occupying lesion. magnetic resonance imaging is a sensitive, non-invasive method to diagnose cerebral tuberculoma. Paradoxical enlargement or development of new tuberculomas during antituberculous therapy is a documented phenomenon which can be overcome by continuation of antituberculous treatment. Twelve months of antituberculous treatment is considered to be adequate to resolve intracranial tuberculoma. ( info) |
| Suprasellar tuberculomas are exceptionally rare and are even rarer in children. A case of suprasellar tuberculoma in a five year old male child who presented with diabetes insipidus, hypothyroidism and visual field defect is described. Deranged CSF parameters, imaging findings of a suprasellar rounded, peripherally enhancing lesion with thickening of the pituitary stalk, led to an accurate diagnosis of tuberculosis. The patient responded well to antituberculous treatment and an unnecessary surgery was avoided. ( info) |