Cerebral Tuberculoma Research Articles

Autopsy case of miliary tuberculosis with cerebral involvement in renal failure

We encountered an autopsy case of renal failure complicated by cerebral tuberculosis. The patient was hospitalized due to disturbance of consciousness, and dialysis therapy was performed because of end-stage renal failure. Approximately 1 week later, abnormal shadows were observed on chest X-ray, and various examinations were performed until the diagnosis was finally determined as miliary tuberculosis. Disturbance of consciousness was exacerbated, despite the administration of antituberculosis drugs and other treatments, and the patient died on the 105th hospital day. Pathological examinations demonstrated miliary tuberculosis associated with intracranial involvement, in addition to contracted kidneys. In patients with end-stage renal failure, the risk of developing tuberculosis, miliary tuberculosis in particular, is reported to be much higher than in normal subjects. However, the diagnosis of miliary tuberculosis is difficult to establish, because of nonspecific symptoms and the low rate of detection of acid-fast bacteria from the sputum. Comprehensive understanding of the results of frequent culture examinations of sputum and blood, contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI), and Polymerase chain reaction (PCR) of cerebrospinal fluid, as well as albumin concentration in the cerebrospinal fluid, are considered useful in diagnosing intracranial tuberculosis. Although cerebral tuberculoma is rare, prolonged disturbance of consciousness may be related to cerebral tuberculosis. Therefore, particular attention should be paid to patients with end-stage renal failure complicated by disturbance of consciousness.

Metastatic adenocarcinoma masquerading as basal pontine tuberculoma

Tuberculous infection of the central nervous system is common in Hong Kong. A 39-year-old woman presented with isolated right sixth nerve palsy which was non-progressive for 10 months. Neuro-imaging revealed a right pontine lesion. Cerebrospinal fluid (CSF) examination showed lymphocytic meningitis with negative bacteriological and cytological studies. Empirical antituberculous drugs with initial corticosteroid resulted in improved CSF parameters. A diagnosis of cerebral tuberculoma complicated by meningitis was made. She subsequently deteriorated clinically and radiologically. Despite a number of clinical features which were atypical of leptomeningeal metastasis, adenosquamous carcinoma was found on biopsy. Her relatively indolent clinical course might be due to the initial corticosteroid treatment. This report illustrates the importance of early tissue diagnosis in uncertain cases of chronic lymphocytic meningitis.

Cerebral tuberculomas in Northern Ireland

Two children presenting with very different clinical pictures were both found to have intracranial tuberculomas. This condition, although rare in developed countries, should be suspected in any child with enhancing cerebral lesions on cranial computed tomography.

Fine structure of epithelioid cells in cerebral tuberculoma

The ultrastructure of epithelioid cells from a tuberculous granuloma in the cerebrum of a 26‐year‐old male was studied. Light microscopic examinations of the border zone of the brain tuberculoma constantly revealed epithelioid cells. Fine structural examinations demonstrated two main types (type 1 and type 2) of epithelioid cells. Both types of epithelioid cells contained similar large pale nuclei. The cell membrane had many finger‐like processes interdigitating with those of the adjacent cells. The type 1 cells were distinguished by the presence of abundant organellae such as lamellar rough endoplasmic reticulum and mitochondria making a dark tone of cytoplasm. The type 2 cells showed a pale cytoplasm containing a few Golgi complexes and associated variably shaped vesicles. Another finding of note in the type 2 cells was the presence of subplasmalemmal linear densities (SLD). The morphology of the type 1 epithelioid cells was reminiscent of that of plasma cells displaying a biosynthetic function. Type 2 epithelioid cells with SLD, however, appeared to have a reduced biosynthetic function and to have contributed to a persistence of the granuloma structure. Neither type revealed identifiable phagocytosed material, and evidence of pinocytosis was practically absent. The presence of morphologic features of transitional cells, intermediate between type 1 and type 2 cells, suggests that these cells are related. It appears likely that type 1 is an early form of type 2. This is supported by the fact that type 2 corresponded roughly to the type ‘B’, which is thought to be a terminal‐stage cell. Furthermore, dying cells exhibited the structure of type 2 rather than type 1 cells.

Central nervous system tuberculoma: a case report

Pediatric cerebral tuberculoma is a disease rarely encountered in the United States. We report a case of central nervous system tuberculoma in a 6-month-old infant who presented to the emergency department with isolated right upper extremity paralysis. The discussion includes a brief review of central nervous system tuberculomas.

A RARE CASE OF CEREBRAL TUBERCULOMAS ASSOCIATED WITH GENITAL TUBERCULOSIS

No AccessJournal of UrologyClinical Urology: Case Reports1 Apr 1998A RARE CASE OF CEREBRAL TUBERCULOMAS ASSOCIATED WITH GENITAL TUBERCULOSIS ROBERTO BONACINA, AUGUSTO VERCESI, GIOVANNI CATANIA, and ORAZIO PRIVITERA ROBERTO BONACINAROBERTO BONACINA More articles by this author , AUGUSTO VERCESIAUGUSTO VERCESI More articles by this author , GIOVANNI CATANIAGIOVANNI CATANIA More articles by this author , and ORAZIO PRIVITERAORAZIO PRIVITERA More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)63593-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "A RARE CASE OF CEREBRAL TUBERCULOMAS ASSOCIATED WITH GENITAL TUBERCULOSIS." The Journal of Urology, 159(4), pp. 1304–1305 References 1 : Tuberculose uro-genitale. Aspects diagnostiques. J. Urol.1995; 101: 187. Google Scholar 2 : Intracranial tuberculomata: case report and review of the literature. Neurology1981; 31: 1133. Google Scholar 3 : Cysticercose cerebral Dix cas. Rev. Neurol. (Paris)1989; 145: 389. Google Scholar Department of Urology, St. Corona Hospital, Milano, Italy.© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 159Issue 4April 1998Page: 1304-1305 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information ROBERTO BONACINA More articles by this author AUGUSTO VERCESI More articles by this author GIOVANNI CATANIA More articles by this author ORAZIO PRIVITERA More articles by this author Expand All Advertisement PDF downloadLoading ...

Mycobacterial infection after liver transplantation.

Tuberculosis occurred in 5 (1.2%) of 462 liver transplant recipients. De novo infection was assumed in 4 patients and a recurrent infection in 1. The clinical courses varied, from asymptomatic open lung tuberculosis to disseminated disease with cerebral tuberculoma and convulsions. Four patients survived with anti-tuberculous triple-drug therapy. Very few cases of tuberculosis after liver transplantation have been reported (4 patients in the medical literature and 5 patients in this paper). However, the incidence, course of infection, and outcome seem to be similar to those of tuberculosis in renal transplant recipients, approximately 150 cases of which are known.

Mycobacterial infection is an important infective complication in British Asian dialysis patients

To define the extent and nature of mycobacterial infection in patients on an adult dialysis unit whose catchment population contains a large proportion of non-Caucasian subjects, a retrospective survey of all new patients accepted onto our maintenance dialysis programme between January 1987 and December 1989 was carried out. Twenty-six Asian, 13 Afro-Caribbean, two Oriental and 170 Caucasian patients were accepted onto the dialysis programme in the three-year recruitment period. Eight of the 26 Asian patients, but none of the others, had developed mycobacterial infection by the end of December 1990. One patient had a cerebral tuberculoma with miliary mottling on chest X-ray, one pulmonary tuberculosis, one tuberculous adenitis and 5 tuberculous peritonitis (four due to Mycobacterium tuberculosis and one Mycobacterium kansasii). All the patients had been living in the UK for an average of 15 (range 6–24) years, with no known recent exposure to tuberculosis. Five patients are now alive and well, one developed malabsorption following M. kansasii peritonitis, but two with tuberculous peritonitis died before treatment could be instituted. Mycobacterial infections were associated with a high level of mortality and morbidity. No Asian patient developed mycobacterial infection during post-transplant immunosuppressive therapy in the study period, probably because of the routine antituberculous chemoprophylaxis employed in this group of patients. The diagnosis of mycobacterial infection should be suspected when an Asian dialysis patient develops a pyrexia of unknown origin. It is likely, though not proven, that anti-tuberculous chemoprophylaxis might reduce this high incidence of tuberculous infection in Asian dialysis patients.

Computed tomography-guided and stereotactic techniques in the diagnosis and treatment of cerebral tuberculoma

The advantages of computed tomography-guided preoperative localization of brain lesions are illustrated in four cases of solitary tuberculoma and in one case of tuberculous abscess of both the cerebrum and the cerebellum. The role of stereotactic diagnostic techniques is emphasized. The clinical presentation and the computed tomography findings in these patients were equivalent to those from glial or metastatic tumors. Synchronous pulmonary tuberculosis was not present in these patients, but in three patients there was metachronous tuberculosis. Tuberculous meningitis had not developed in any of the patients.

Disseminated tuberculosis of the central nervous system responsive to rifabutin

Multiple cerebral tuberculomas are now very rare. We report the case of a young man with an 8-month history of headache, febricula and abscess of the left tibiotarsal joint, which was found to contain mycobacterium tuberculosis. Chest X-rays revealed miliariform dissemination to both lungs while CT and MR brain scans revealed numerous small nodules, especially in the posterior cranial fossa. Despite anti-tuberculosis therapy the patient developed a right pyramidal hemisyndrome and intracranial hypertension. The inclusion of rifabutin in the treatment schedule was followed by rapid improvement and a year later the patient was in good health and free from cerebral and pulmonary lesions. The interest of the case lies in the multiplicity of sites of the TB process in a non immunodepressed patient, the dissemination to the CNS without meningeal involvement, the resistance to standard antimycobacterials and the swift response to rifabutin.

Disappearing CT lesions in epilepsy.

A striking but reversible computed tomographic (CT) lesion corresponding to seizure activity is reported in a series of 46 epileptic patients. None of these patients had evidence of tuberculosis or cysticercosis, and all were treated with antiepileptic drugs only. Maximal radiological changes occurred in the area of maximal epileptic discharge; however, multiple lesions were seen in three cases. The CT lesion reappeared with recurrence of the ictus in four cases during follow-up, and this, too, disappeared after complete arrest of the seizures. The clinical, CT scan, and other investigatory findings suggest that the seizures may occasionally cause a CT-demonstrable focal abnormality, probably cerebral edema, a consequence of abnormal vascular permeability. Awareness of this radiological entity should avoid misdiagnosis of cerebral tumor, infarction or tuberculoma in patients with seizure disorder.

Computed tomography of cerebral tuberculoma.

The CT findings in nine cases of cerebral tuberculoma are illustrated. Larger tuberculomas frequently show a ring-like enhancement after contrast medium infusion, whereas the smaller lesions display a more homogeneous enhancement. The tuberculoma's course toward regression and complete disappearance during conservative management can be followed by CT.

Computed tomography in CNS tuberculosis.

Computed tomography (CT) was performed in 14 cases of tuberculous meningitis (TBM), 12 of which were examined during the acute phase of the disease. CT findings in these cases included internal hydrocephalus (6/12), internal combined with external hydrocephalus (2/12), focal lesions consistent with localized encephalitis (3/12), diffuse brain edema (1/12), and middle cerebral artery infarction (1/12). In comparison to 32 cases of nonspecific bacterial meningitis, internal hydrocephalus was found significantly more often in TBM than in nonspecific meningitis (p less than 0.01) making CT an additional tool for the differentiation of these conditions in doubtful cases. In addition, CT features of 2 cases of cerebral tuberculoma are presented.

Extrapulmonary Tuberculosis in Saudi Arabia.

ABSTRACT A review of 162 patients with active tuberculosis seen at the King Faisal Specialist Hospital and Research Centre between January 1979 and April 1981 was carried out. Patients with classic...

Intraventricular administration of rifampin for tuberculous meningitis

A case of tuberculous meningitis associated with cerebral tuberculomas, and resistant to antituberculous therapy is reported. Repeated injections of rifampin, administered through an intraventricular Ommaya drain, provided an effective control of the meningeal infection.

CEREBRAL TUBERCULOMAS DEVELOPING DURING TREATMENT OF TUBERCULOUS MENINGITIS

Cerebral tuberculomas developed in two adult Asian immigrants during treatment for miliary tuberculosis and tuberculous meningitis. Both were infected by strains of Mycobacterium tuberculosis sensitive in vitro to all antituberculous drugs, and no evidence of immunodeficiency was detected. Focal neurological signs appeared and the lesions led to the death of one patient despite maximum treatment. The importance of systemic corticosteroids in controlling the raised intracranial pressure is discussed.

The neuroradiological findings in a case of cerebral tuberculoma.

This paper describes the neuroradioloigical findings in a case of cerebral tuberculoma. Computed tomography demonstrated a mass in contact with the cranial bone with marked contrast enhancement and accompanied by perifocal cerebral edema. External carotid angiography revealed a homogenous stain supplied from the middle meningeal artery. Furthermore, by radioisotope scan it appeared to be a region of increased uptake with a comparatively clear border and was thereby misdiagnosed as meningioma.

Tuberculoma of the Brain

Four patients with cerebral tuberculomas had presenting manifestations that included seizure disorder, exophthalmos, or extremity weakness. Although rare in this country, this diagnosis should not be overlooked in such patients, since combined surgical and medical therapy may be curative.

Tuberculoma of the brain (revisited).

Cerebral tuberculoma mimics brain tumor, both clinically and radiographically.The patient often presents with seizures of recent onset; angiograms usually show a relatively avascular mass lesion associated with considerable edema.In 2 of the 3 cases in this report the brain scan was positive, suggesting that this will now be an increasingly important diagnostic modality.Although the over-all incidence of tuberculosis has declined in the United States, it still remains an important medical problem in deteriorated urban areas. A high index of diagnostic suspicion as to the possibility of tuberculoma in brain tumor suspects, particularly in hospitals serving such areas, may help towards a favorable therapeutic outcome.

Tuberculomas cerebrais múltiplos em lactente

É relatado um caso de uma menina com 11 meses de idade, apresentando distrofia de III.º grau, desidratação e processo pleuro-pulmonar grave. Após a hospitalização ocorreu paralisia facial periférica à direita, progredindo e quadro neurológico para paralisia de ambos os nervos motores oculares externos, do pneumogástrico e do glossofaríngeo. Após evolução rápida para o coma, ocorreu o óbito, tendo a autópsia mostrado tuberculose pulmonar, mesentérica e cerebral. O caso é discutido quanto à idade da paciente, à multiplicidade e localização dos tuberculomas encefálicos, ao quadro clínico apresentado, ao encontro de bacilos de Koch nos tuberculomas intracranianos e à normalidade do líquido cefalorraqueano.