Professional Documents
Culture Documents
05 Intracranial
05 Intracranial
Tayseer M. Zein, MBBS, MRCP (UK), Peter S. Fletcher, MD, FRCPath, Zein M. Mirghani, BSc, PhD.
ABSTRACT
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.
Keywords:
From the Department of Medicine and Pathology, Armed Forces Hospital Southern Region, Khamis Mushat (Zein, Fletcher) and the Department of
Biochemistry, College of Medicine, King Saudi University, Abha, (Mirghani), Kingdom of Saudi Arabia.
Published with special permission from Saudi Medical Journal.
Address correspondence and reprint request to: Dr. T. Zein, Armed Forces Hospital, Southern Region, PO Box 101, Khamis Mushayt, Kingdom of
Saudi Arabia. Tel/Fax. +00966 (7) 2511550. Fax. +00966 (7) 2247570.
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Age/Sex
34/m
27/M
41/F
58/F
60/F
65/M
Nationality
Saudi
Indian
Saudi
Saudi
Saudi
Saudi
Immuno-compromised status
No
No
No
No
No
Clinical presentation
Tuberculous
meningitis
Headache,
diplopia
Seizures
Left-dense
hemiplegia
Left hemiparesis
None
None
None
None
None
None
Papilloedema
No
No
No
No
No
No
Chest x-ray
Negative
Negative
Negative
Negative
Negative
Negative
12 mm/hr
6mm/hr
19mm/hr
20mm/hr
10mm/hr
7mm/hr
Tuberculin test
Not done
Note done
5mm positive
Not done
Not done
Not done
Localization of tuberculoma
Supra and
infratentorial
Infratentorial
Supratentorial
Supratentorial
Supratentorial
Supra and
infratentorial
Multiple masses
with high signals
Solitary occipital
mass with
extensive edema
Multiple lesions
with intense
enhancement
Solitary parietal
mass with
massive edema
Brain biopsy
Not done
Multiple
caseating
granuloma
Caseating
granulomas
Caseating
granuloma
Not done
Not done
Not done
Negative
Positive
Negative
Not done
Not done
Response to antituberculous
medication
Moderate
Complete cure
Complete cure
Complete cure
Poor
Complete cure
Epilepsy visual
field defect
None
None
None
Left dense
hemiplegia
None
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Right multiple
Multiple
enhancing lesions enhancing lesions
plus right falx
meningioma
References
1. Rieder HL, Sinder DE Jr., Cauthen GM. Extrapulmonary
tuberculosis in the United States. Am Rev Respir Dis 1990;
141: 347-351.
2. Danergis JA, Leftwich EI, Curtin JA, Witorsh P.
Tuberculoma of the brain. JAMA 1978; 239 (5): 413-415.
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