Cerebellar Tuberculoma Research Articles

Abducens Nerve Palsy as the Only Presenting Symptom for Solitary Cerebellar Tuberculoma in an Immunocompetent Young Adult

Abducens Nerve Palsy as the Only Presenting Symptom for Solitary Cerebellar Tuberculoma in an Immunocompetent Young Adult

Isolated 3rd Nerve Palsy Presenting in a Background of Multiple Cerebellar Tuberculoma with Tubercular Meningitis

Isolated 3rd Nerve Palsy Presenting in a Background of Multiple Cerebellar Tuberculoma with Tubercular Meningitis

Intracranial giant tuberculoma: A 7-year institutional experience and literature review

BackgroundIntracranial tuberculomas are infrequent with a lower morbidity and mortality compared to tubercular meningitis. Giant intracranial tuberculomas are rarer but important differentials for intracranial space-occupying lesions causing focal neurological deficits depending on anatomical location and size. MethodsHistopathologically confirmed giant intracranial tuberculomas selected based on institutional size criteria (<12 Years-old: ≥25 mm; 12–18 Years-old: ≥35 mm; ≥18 Years-old: ≥40 mm) were retrospectively reviewed and analyzed for clinical features, radiology, surgical management, and outcomes in patients admitted from 2015 to 2022. ResultsTen patients were included (Males:Females = 3:7; Age: 8–68 Years, Average: 30.1 Years). Mean duration of symptoms was 2.84 months. Two patients demonstrated active systemic tuberculosis. Previous tubercular infections included pulmonary involvement in four, meningeal in three, and a cerebellar tuberculoma in one patient. Cerebrospinal fluid analysis in five patients demonstrated no tubercle bacilli. Seven lesions were supratentorial and three infratentorial. Giant tuberculomas demonstrated profound T2 hypointensity, sub-marginal T2 hyperintense crescents, and significant perilesional vasogenic edema. Craniotomy and excision were mainstay except in one case treated only with ventriculoperitoneal shunting. Three additional patients underwent ventriculoperitoneal shunting for hydrocephalus. One patient died from aspiration pneumonia and sepsis following a postoperative seizure. Anti-Tubercular Therapy (ATT) was advised for 18 months. Follow up ranged from 4 to 18 months. One patient was medically managed for ATT-induced hepatitis, hepatic encephalopathy, and coincidental paradoxical reaction. Remainder of patients showed complete resolution of symptomatology and absence of new symptoms till latest follow up. ConclusionClinical course of giant tuberculomas differ from non-giant variants in characteristic radiology, more intensive ATT, and possibility for partial debulking/excision.

Cerebellar tuberculoma in an immunocompetent patient

Background: Tuberculosis infection of the Central Nervous System is the major cause of death and morbidity in developing countries. The clinical manifestations and radiological findings in tuberculoma are nonspecific. This article reports a rare case of cerebellar tuberculoma with the manifestation related to an intracranial mass and without the typical clinical symptoms of Tuberculosis in an immunocompetent patient. Case Report: A 20-year-old female with seizure, headache, and vertigo. A mass in the posterior fossa was revealed by Magnetic Resonance Imaging. Thorax scan results showed the Tuberculosis process. The patient then underwent surgery. Histopathological examination displayed chronic granulomatous inflammation and the presence of Acid-Fast Bacilli. The patient received anti-tuberculous drug treatment for one year and anti-seizure medication. Discussion: Cerebellar tuberculoma can resemble an intracranial tumor or cranial abscess. Diagnosis is based on clinical, radiological manifestations, and histopathological analysis. Surgical intervention still has a role in the treatment of this disease. The finding of Mycobacterium tuberculosis on histopathological examination is the gold standard in diagnosing Tuberculosis. Conclusions: Although it is rare, the involvement of Tuberculosis in the CNS should be taken into account in both immunocompetent and immunocompromised patients with neurological symptoms who are living in an endemic area.

A malignant disseminated tuberculosis: concurrent intracranial tuberculosis with skipped multilevel spondylitis in a young immunocompetent patient

Background/aim. Mycobacterium tuberculosis (M. tuberculosis) infection can cause pulmonary and extrapulmonary tuberculosis (TB), resulted from hematogenous or lymphatic dissemination of the bacteria. Disseminated TB is characterized by the presence of two or more non-contiguous sites from the spread. Dissemination to the central nervous system (CNS TB) has several manifestations that can cause devastating neurological complications. Several predisposing factors include older age, human immunodeficiency virus (HIV) coinfection, and pharmacological immunosuppression. As the manifestation of CNS TB itself is rare, diagnosing it remains a challenge. Prompt antituberculosis treatment is needed to improve patient’s outcome. This paper aims to present a rare case of malignant disseminated TB in a young immunocompetent patient. Case. This case presents an immunocompetent 17-year-old male with weakness in the four extremities. Through comprehensive history taking and examination, the patient was diagnosed with malignant disseminated TB, presenting as cerebellar tuberculoma, tuberculous meningitis, and multiple skipped level spondylitis TB; and concurrent pulmonary TB. Then, the patient underwent a surgery for the cervical lesion and was started on antituberculosis treatment in combination with corticosteroid. After the treatment, the patient’s motoric and sensoric functions improved and he was able to urinate and defecate normally. Conclusion. This case demonstrates the importance of considering disseminated TB in the differential diagnosis of a patient with neurological deficits, regardless of the fact that the patient is young and immunocompetent. Prompt diagnosis and rapid initiation of treatment can improve the patient’s outcome.

Abducens nerve palsy: A sole presentation of isolated cerebellar tuberculoma

Tuberculomas constitute 5–30% of the space-occupying lesions of the central nervous system (CNS) in developing countries, and children and young adults are the most affected population. Most CNS tuberculomas include focal neurological signs with evidence of either meningeal exudates or hydrocephalus, but presentation as isolated sixth nerve palsy is very rare. We report a case of an immunocompetent female who presented with double vision, and was found to have isolated abducens nerve palsy of the right eye. On magnetic resonance imaging of the brain, solitary cerebellar tuberculoma was identified without any evidence of meningitis, basal exudate, or hydrocephalus. Despite the prompt initiation of anti-tubercular drugs and steroids, negligible improvement was noticed at 2 weeks of follow-up. This report highlights that isolated tuberculoma of any unrelated brain region can cause lateral rectus palsy, which may result in permanent disability.

Tuberculosis in the paediatric age group: a reflection on transmission

IntroductionPaediatric tuberculosis (TB) disease continues to be a challenge. Difficulties in its diagnosis and limited experience on its treatment in children are some of the reasons to consider the need for specialized paediatric TB centres and to prioritize children in tuberculosis control programmes, particularly in low-incidence countries. We describe the paediatric tuberculosis cases managed in a specialized paediatric outpatient TB centre. Patients and MethodsWe conducted a retrospective analysis of epidemiological and clinical data on TB cases in patients aged less than 18 years in the period ranging from January 2007 to June 2017. ResultsWe identified 46 cases of TB. The median age of the patients was 5 years (IQR, 1.75−13.25). Thirty cases (65.2%) were identified through screening following exposure to TB. Thirty-six children (78%) presented with a median duration of symptoms during 2 weeks, the most frequent being cough (54%) and fever (48%). The findings of the chest radiograph were abnormal in 73.9% of patients, and a CT scan was performed in 82.2%, the findings of which contributed significantly to the decision to treat in 85.3%. Despite collection of different microbiological specimens, diagnostic confirmation was possible in only 12 cases (26.1%). The results of culture and/or nucleic acid amplification tests were positive in 33.3% of samples of sputum, 28.1% of bronchoalveolar lavage and 12.9% of gastric aspirates. The most frequent diagnosis was pulmonary TB (n=31), followed by pleuropulmonary TB (n=6), lymph node disease (n=3), uveitis (n=2), bone tuberculosis, disseminated TB, cerebellar tuberculoma and erythema nodosum (each n=1). ConclusionsTuberculosis in children is an epidemiological indicator of recent transmission of Mycobacterium tuberculosis in the community. Efforts must be made to collect microbiological specimens before initiating treatment whenever possible. Management by an experienced paediatrics team allows an accurate diagnosis even when microbiologic confirmation is not possible.

Cerebellar Tuberculoma in a Patient with Lung Tuberculosis New Case: A Case Report

Background: Tuberculosis (TB) is an infectious disease which can occur in the lungs and extra lung. One kind of extra lung TB is Cerebellum tuberculoma, which is one of rare manifestations form of TB, difficult to diagnosed, because sign and symptom is not specific.Case: A 17-year-old female presented a TB symptoms. She also had contact with her neighbor that was diagnosed with TB. In physical examination there was reduced motor function on her right extremities. Chest radiology revealed opacities in 2/3 superior in the left lung before treatment. Computed Tomography (CT) head scan with contrast showed ring contrast enhancement in left subcortical hemisphere cerebellum with size as 1.8 x 1.8 x 1.7 cm. Multiple lymphadenopathy in right-left upper-aid jugular and lymph node subcentimeter in right of submandibular, right-left lower jugular with varieties of size, the biggest is 1.6 x 1.5 cm. After 6 months treatment the tuberculoma of cerebellum was gone. Conclusion:Cerebellum tuberculoma is a rare presentation of active TB. Radiological imaging plays an important role in the diagnosis and monitoring of the disease. The appereance of tuberculoma on our patient CT showed nodular-enhancing lesion. Intracranial tuberculoma should be treated conservatively, since the majority of these lesions resolve completely with Anti-Tuberculosis Drugs (ATD). Our patient started ATD and the lesions completely disappeared within 6 months. We wanted to present our case due to well-responded to ATD and being an example of atypical presentation of tuberculosis both clinically and radiologically.

Concurrent intramedullary and intracranial tuberculoma: A rare association

Tuberculous meningitis is the most common manifestation of neurotuberculosis. The incidence of spinal intramedullary tuberculoma is still an uncommon presentation even in a country like India, where the burden of tuberculosis is high. A combination of intramedullary, cerebellar, and cerebrum tuberculoma is rare. We report a case of symptomatic cervical and dorsal intramedullary tuberculoma without bladder involvement and asymptomatic cerebellar and temporal lobe tuberculoma.

Cerebellar Tuberculoma in a HIV Coinfected Patient with Arnold-Chiari I Malformation

Cerebellar Tuberculoma in a HIV Coinfected Patient with Arnold-Chiari I Malformation

Suprasellar tuberculoma

Tuberculosis is among the most lethal infectious diseases. Although incidence of intracranial tuberculosis is low in developed countries, it is still rampant in the developing world. The most common location of intracranial tuberculomas in adults is the cerebral hemisphere, and in children, the posterior fossa. The suprasellar tuberculomas are extremely rare and pose a diagnostic challenge. We describe a patient with concomitant suprasellar and cerebellar tuberculoma.

Transient Behavior Abnormality following injury to Splenium of Corpus Callosum during Ventriculoperitoneal shunt Surgery

A case of cerebellar tuberculoma, 17 year old girl, presented with complaints of headache, blurring of vision and difficulty in walking. Non-contrast computed tomography of head revealed obstructive hydrocephalus and a hypodense space occupying lesion in cerebellum. Magnetic resonance imaging (MRI) of brain with contrast enhancement revealed large conglomerate cerebellar tuberculomas with obstructive hydrocephalus. She received antitubercular therapy and Right Ventriculoperitoneal shunt (VP shunt) surgery was done. In immediate post operative period she developed behavior abnormality for a brief duration which improved with conservative treatment. In the early post operative period and during follow up, the patient developed various complications but at the end of 1 year follow up she was cured of the disease without any residual deficit. Keywords - Behaviour abnormality, Corpus callosum, Tuberculoma, Ventriculoperitoneal shunt

Headache and Central Positioning Vertigo in a Middle Aged Female-a Case of Solitary Cerebellar Tuberculoma Involving Left Cerebellar Hemisphere

Headache and Central Positioning Vertigo in a Middle Aged Female-a Case of Solitary Cerebellar Tuberculoma Involving Left Cerebellar Hemisphere

Cerebellar tuberculoma presenting as haematoma – a case report and pathophysiological consideration

Intracranial tuberculoma represents the most common mass lesion in neurotuberculosis. We report an unusual case of tuberculoma with haemorrhage presenting clinically as a cerebellar haemorrhage. Cranial CT scan revealed a peripherally enhancing cerebellar mass with haemorrhage and obstructive hydrocephalus, requiring urgent surgical evacuation of the haematoma. Histopathological examination revealed tuberculoma with features of phlebitis. In view of the pathological evidence of phlebitis in the lesion, it could represent an immune-mediated acute haemorrhagic leucoencephalitis in response to tubercular antigens.

Tuberculome géant du cervelet simulant une tumeur maligne

Isolated central nervous system (CNS) tuberculoma is rare. Central nervous system tuberculosis (TB) is associated with high morbidity and mortality despite modern methods of detection and treatment. The authors report a case of a giant cerebellar tuberculoma mimicking a malignant tumor and review the literature. A six-year-old girl, with no past medical history, vaccinated for her age, presented with a three-month history of occipitocervical cephalalgia, complicated by gait disturbances. The MRI showed a left cerebellar tumor suggestive of a medulloblastoma. At surgery, a nodular, avascular lesion was found and pathological examination confirmed tuberculoma. Intracranial tuberculoma is an uncommon variety of central nervous system tuberculosis. The prognosis is related to the rapidity of diagnosis, surgical resection and the complementary antituberculosis treatment. Intracranial tuberculoma is an uncommon variety of central nervous system infection. Prognosis is improved by a quick diagnosis, surgical removal, and associated antituberculoma therapy.

Cerebellar Tuberculoma

A case of a solitary cerebellar tuberculoma in a 67-year-old male is presented. The patient showed signs and symptoms of acute obstructive hydrocephalus, necessitating surgical removal of the tumor. Combined treatment with antituberculosis drugs, not only pre and postoperatively but also intraoperatively, proved beneficial, and postoperative meningitis did not develop. Steroids also produced dramatic clinical improvement without causing spread of the tuberculosis. Since intracranial tuberculoma is rarely encountered in present-day Japan, it is not likely to be considered when signs and symptoms suggest an intracranial mass lesion. Therefore, it must be emphasized that the first and most important step in the diagnosis of intracranial tuberculoma is to suspect it. The incidence and ages of patients as well as the locations of intracranial tuberculomas, their relationship to tuberculous abscesses, neuroradiological features, and therapeutical methods are reviewed.