Abstract
A 52-year-old female presented with headache and double vision for one and half month. On examination of eye a horizontal nystagmus was seen in leftward gaze. Magnetic resonance imaging (MRI) brain showed multiple small rim and nodular enhancing lesion with mild perilesional edema in cerebral and cerebellar hemisphere and pons. Patient’s ESR was 70, and mountoux test was 14 mm after 72 hours. On the basis of MRI and investigations, and endemicity of tuberculosis in India, diagnosed as a case of tuberculoma and treated with anti tubercular treatment. She had 3 months of follow-up period and showed a complete amelioration of symptoms.
Highlights
Tuberculosis is a major health problem in developing countries; tuberculoma involving the central nervous system is still uncommon as compared to involvement of other systems [1]
Clinical manifestations of tuberculoma depend largely on their site and patients often presents with headache, seizures, papilledema or other signs of increased intracranial pressure
We report a patient with atypical presentation of tuberculoma, presenting with headache and diplopia with only positive examination finding of unilateral horizontal gaze evoked nystagmus
Summary
Tuberculosis is a major health problem in developing countries; tuberculoma involving the central nervous system is still uncommon as compared to involvement of other systems [1]. We report a patient with atypical presentation of tuberculoma, presenting with headache and diplopia with only positive examination finding of unilateral horizontal gaze evoked nystagmus. A 52 year old female admitted to hospital with symptoms of headache and double vision (diplopia) increased on leftward gaze since 45 days. She was non diabetic, non hypertensive, and there was no history of tuberculosis. Non hypertensive, and there was no history of tuberculosis Her weight was 52 kg, BMI 17.1 kg/m2, pulse rate 84/min, B.P. 110/70 mmHg. On examination there was no proptosis, visual acuity in both eyes were 6/6 and anterior segment was normal. Patient treated with antitubercular drugs [rifampicin, isoniazid, pyrazinamide and streptomycin] and steroid therapy [oral dexamethasone given for 4 week and tapered over 4 week] and reviewed patient monthly, patient symptoms gradually improves with complete amelioration after 3 months
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