Abstract
The MRI demonstrated a T1-weighted isointense and T2weighted hyperintense extra-axial homogeneously enhancing mass over the right frontotemporal convexity associated with marked oedema and midline shift. The histopathology demonstrated extensive necrotising granulomatous inflammation with acid-fast bacilli identified on Ziehl-Neelsen staining. The specimen culture polymerase chain reaction test was positive for Mycobacterium tuberculosis. Cerebral tuberculoma is an uncommon manifestation of central nervous system (CNS) tuberculosis (TB) and presents in only 15% to 30% of all CNS TB. It appears as localised tuberculous masses histologically characterised by granulomatous caseating necrosis. While most are intraparenchymal, extra-axial tuberculomas are rare but well-recognised variants of cerebral tuberculoma. Meningeal tuberculomas, as reported here, are rarer, with only 12 cases reported in the English literature. Diagnosis of both intraparenchymal and extra-axial tuberculomas radiologically is often difficult, with cases commonly misdiagnosed initially as a neoplasm. en-plaque meningiomas. The MRI appearance is variable, with hypointensity or isotensity on T1weighted and hypointensity, isointensity or hyperintensity on T2-weighted MRI. Similar to meningioma, tuberculomas enhance strongly on gadolinium contrast. In addition, an unremarkable clinical history and a negative TB screening investigation do not eliminate the possibility of tuberculoma. In recent years, magnetic resonance spectroscopy has been reported to be able to differentiate extra-axial tuberculoma radiologically. Both neurosarcoidosis and CNS lymphoma can have similar radiological appearance, being isointense and hyperintense on T1-weighted and T2-weighted MRI respectively with gadolinium enhancement. MRI findings of neurosarcoidosis include periventricular and white matter lesions, multiple intracerebral lesions and leptomeningeal enhancement. Angiotensin-converting enzymes are commonly normal in neurosarcoidosis. Meningeal lymphoma may result from dissemination of aggressive lymphoma,
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