CASE REPORT: A CASE OF INTRACRANIAL TUBERCULOMA MASQUARADING AS A NEUROCYSTICERCOTIC LESION

Abstract

Central nervous system manifestations of tuberculosis are the worst kind of manifestations of tuberculosis and should be ruled out . Since it can be critical to patient's diagnosis. Thus , we present to you such a case where we were able to diagnose the patient in the early stage. A 26 year old male patient , presented to the emergency medicine department with history of 1 episode of loss of consciousness , 1 episode of seizures and right sided weakness in an irritable state. He was also a known alcoholic and also consumed a mixed diet . The patient was admitted to the ICU in view of drowsiness and headache and was observed there for 24 hours..His CT Scan done outside showed showed calcied granulomas in the left parietal lobe suggesting ?Neurocysticercosis. His other investigations were found to be within normal limits. His Fundus did not reveal any evidence of oculocysticercosis or papilledema. CSF was found to be normal. He was started on Tab Albendazole intended for a course of 30 days , Inj Dexamethasone , Inj Mannitol, Inj levetiracetam Inj Ceftriaxone, and other medications . His MR Spectroscopy suggested a well dened conglomerated , ring enhancing lesion with heterogeneously T2/FLAIR iso to high and T1 hypodensity seen in left parietal lobe with surrounding edema and mass effect. Features favouring granulomatous infective etiology,differential diagnosis: 1]Tuberculoma 2] Neurocysticercosis.. The choline is to creatinine ratio was high to differentiate it from a neurocysticercosis lesion yet not too markedly elevated to be called a malignancy and hence conrmed that the ring enhancing lesion was tuberculoma . Glioma was ruled out as the ring enhancing lesions of the glioma kind usually have irregular margins and are usually mixed density. However, here .[2] Thus , he was started on anti tubercular treatment , presently the patient is doing well.