Brain Tuberculoma Research Articles

Brain Tuberculoma in a Non-endemic Area

Brain tuberculoma has previously accounted for up to a third of new intracranial lesions in areas endemic with tuberculosis, but is unexpected in the United States and other Western countries with improved disease control. Here we show the importance of considering this diagnosis in at-risk patients, even with no definitive pulmonary involvement. We describe a young man who presented with partial seizures and underwent craniotomy for resection of a frontoparietal tuberculoma. He subsequently completed six months of antituberculosis therapy and was doing well without neurological sequelae or evidence of recurrence five months after completion of therapy. With resurgence of tuberculosis cases in the United States and other Western countries, intracerebral tuberculoma should remain a diagnostic consideration in at-risk patients with new space occupying lesions. Mass lesions causing neurological sequelae can be safely addressed surgically and followed with antituberculosis therapy.

Multiple Tuberculoma in Brain Presented with Isolated Ocular Abnormality: A Case Report

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.

Surgical management of double giant tuberculomas of brain involving both supratentorial and infratentorial compartments

Surgical management of double giant tuberculomas of brain involving both supratentorial and infratentorial compartments

Disseminated tuberculosis with paradoxical miliary tuberculomas of brain in a child with rickets

Intracranial tuberculomas continue to be a serious complication of central nervous system tuberculosis. Multiple central nervous system tuberculoma is commonly associated with human immunodeficiency virus (HIV) infection. The development of intracranial tuberculomas has been thought to be caused by hematogenous spread of tubercle bacilli on the surface of brain parenchyma from the primary site of infection. Here, we describe the case of a 5-year-old male child with severe protein energy malnutrition (Marasmus) having large cervical lymphadenopathy and severe nutritional rickets with deformity at presentation. The child developed convulsions 20 days after initiation of antituberculous drugs, and neuroimaging confirmed multiple miliary tuberculomas of brain as primary etiology for the convulsions.

Isoniazid- and Streptomycin-Resistant Miliary Tuberculosis Complicated by Intracranial Tuberculoma in a Japanese Infant

In Japan, the incidence of severe pediatric tuberculosis (TB) has decreased dramatically in recent years. However, children in Japan can still have considerable opportunities to contract TB infection from adult TB patients living nearby, and infants infected with TB may develop severe disseminated disease. A 3-month-old girl was admitted to our hospital with dyspnea and poor feeding. After admission, miliary TB and multiple brain tuberculomas were diagnosed. Anti-tuberculous therapy was initiated with streptomycin (SM), isoniazid (INH), rifampicin and pyrazinamide. Symptoms persisted after starting the initial treatment and mycobacterial cultures of gastric fluid remained positive. Drug sensitivity testing revealed the TB strain isolated on admission as completely resistant to INH and SM. Treatments with INH and SM were therefore stopped, and treatment with ethambutol and ethionamide was started in addition to rifampicin and pyrazinamide. After this change to the treatment regimen, symptoms and laboratory data gradually improved. The patient was treated with these four drugs for 18 months, and then pyrazinamide was stopped. After another 2 months, ethambutol was stopped. Treatment of tuberculosis was completed in 24 months. No adverse effects of these anti-TB drugs were observed. The patient achieved a full recovery without any sequelae. On the other hand, the infectious source for this patient remained unidentified, despite the extensive contact investigations. The incidence of drug-resistant TB is increasing in many areas of the world. Continuous monitoring for pediatric patients with drug-resistant TB is therefore needed.

Optochiasmatic tuberculoma as the sole manifestation of late recurrent tuberculosis

Brain tuberculomas account for 10-20% of space occupying brain lesions in developing countries. Most lesions are observed at time of tuberculosis diagnosis or soon after starting treatment. We herein describe a 32 year-old patient with a 14-month history of headache and progressive visual loss. Her past medical history revealed pulmonary tuberculosis treated eight years before. A brain MRI showed a T1- and T2-weighted isointense contrast-enhancing lesion in the optic chiasm. A presumptive diagnosis of optochiasmatic tuberculoma was made and isoniazid, rifampin, pyrazinamide, and ethambutol were started. Despite treatment, the patient evolved to blindness. The prompt recognition of this condition is extremely important since the presence of optochiasmal enhancement is associated with blindness in patients with tuberculosis.

Parenchymal Brain Tuberculoma in a Patient With Sickle Cell Disease

Parenchymal Brain Tuberculoma in a Patient With Sickle Cell Disease

Tuberculoma cerebral que simula un tumor maligno

Tuberculous involvement of the central nervous system is uncommon in western countries. Brain tuberculoma is a granulomatous inflammatory process than in rare occasions can simulate a malignant neoplasm.A 81-year-old man regarding symptoms of several weeks of evolution of numbness affecting upper limb and right face. The neuroimaging studies showed a left parietal lesion suggestive of a primary malignant tumor. A stereotactic biopsy was performed and the pathological examination showed a brain tuberculoma. The patient was treated with anti-tuberculous drugs.Parenchymal central nervous system tuberculosis are rare in our medio and may present as a space-occupying lesion with complex neuroimaging morphology suggesting a malignant neoplasm. Definitive diagnosis was performed with neuropathological studies or with the demonstration of acid-fast bacilli in the tuberculoma.

Paradoxical Worsening of Brain Tuberculomas During Treatment

Marco A. Lima. Fundacao Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado a Fiocruz, mas nao consta a informacao no documento.

Tuberculoma intracraneal simulando neoplasia maligna: Caso clinico y revision de la literatura

Extrapulmonary manifestations of tuberculosis involving the central nervous system (CNS) due to haematogenous spread are not a rare entity. Tuberculoma is a granulomatous inflammatory process mimicking in rare occasions a malignant neoplasm radiologically. The authors report a case of a giant right frontal tuberculoma mimicking a malignant tumor and review the literature. A sixty four-year-old women with several weeks of headache and behavior alterations admitted at the hospital with light right hemiparesis. The MRI showed a left frontal tumor suggestive of a malignant tumor. CT showed bone infiltration. At surgery, a nodular, avascular lesion was found and pathological examination confirmed granulomatous inflammation suspecting tuberculoma. Mycobacterium tuberculosis complex-specific PCR assay confirmed diagnosis. Intracranial tuberculoma is an uncommon variety of central nervous system tuberculosis. The prognosis is related to the early diagnosis, surgical resection and the complementary antituberculosis treatment. We present the unusual presentation of a giant brain tuberculoma which MRI led us to believe was a malignant tumor. Computed Tomography revealed bone infiltration. Positive diagnosis could be established on the basis of the pathology results of a brain biopsy or detection of DNA of Mycobacterium tuberculosis in the PCR study.

A case of multiple tuberculomas in brain presenting as hemiparesis

Tuberculosis of central nervous system can be present in many different clinical and radiological patterns with disseminated or miliary brain tuberculomas as a rare presentation. Multiple central nervous system tuberculoma is commonly associated with human immunodeficiency virus (HIV) infection. Tuberculomas develop following haematogenous dissemination of bacilli from an infection elsewhere in the body, usually lung. Here we describe a case of immunocompetent host with a past history of pulmonary tuberculosis, presenting with headache and generalised weakness, and later was diagnosed as a case of multiple tuberculoma brain.

Brain tuberculoma (Mycobacterium africanum): high index of suspicion helps in avoiding biopsy/surgery

Partial seizures can be due to a growing cerebral lesion, which may be tumoral or inflammatory/infectious in nature. The differential diagnosis is obviously important; increasing immigration to Europe from Africa is leading to an increase of infectious disease involving also the central nervous system. The authors report imaging the a case of a brain tuberculoma due to Mycobacterium africanum mimicking brain tumor, in which diagnosis was possible by inoculum in guinea-pig of material obtained by mediastinal biopsy of enlarged lymph nodes. Specific treatment led to marked reduction in the size of the brain lesion.

PP-203 Tuberculosis meningitis, multiple brain tuberculoma and ocular involvement in a 20-year-old man

PP-203 Tuberculosis meningitis, multiple brain tuberculoma and ocular involvement in a 20-year-old man

The diagnosis of brain tuberculoma by 1H-magnetic resonance spectroscopy

Toddlers are more prone to develop severe and extrapulmonary tuberculosis (TB) than older children. This is partially explained by differences in the immune response. Early and specific diagnosis is essential to start adequate treatment, especially if the central nervous system (CNS) is involved. The lack of sputum production and inherent dangers or impossibility of sampling CNS lesions may delay diagnosis. In addition, the magnetic resonance imaging (MRI) features of TB abscesses are non-specific and may mimic abscesses of other infectious etiology. (1)H-magnetic resonance spectroscopy ((1)H-MRS) may increase specificity of diagnosis by identifying lipids within the lesions that are considered characteristic for TB. Therefore, we studied four children with presumable CNS-TB with MRI and (1)H-MRS. In vivo and in vitro (1)H-MRS showed elevated lipid peaks within the TB lesions. (1)H-MRS allows to non-invasively identifying TB with high specificity and may allow early installment of targeted antimicrobial treatment.

Brain tuberculomas, tubercular meningitis, and post-tubercular hydrocephalus in children.

Central nervous system tuberculosis in children presents commonly as tubercular meningitis, post-tubercular meningitis hydrocephalus, and much more rarely as space-occupying lesions known as tuberculomas. The occurrence of this condition, though previously reported only in the developing world, is now frequently reported in human immunodeficiency virus positive migrants in the western world. The exact pathogenesis of this condition is still incompletely understood, and the mainstay of treatment is chemotherapeutic regimes. Neurosurgical intervention is rarely necessary, and is confined to cases of hydrocephalus after tubercular meningitis and to large tubeculomas with space-occupying effects.

Plant Root Hair in Tap Water: A Potential Cause for Diagnostic Confusion

Plant root hairs are commonly found artifacts in parasitology specimens and may be confused with helminthes by an untrained eye. We report a case of brain tuberculoma where the tissue sample was contaminated with root hair derived from tap water; the presence of this root hair, which mimicked a larva, led to diagnostic confusion. Therefore, tap water should be considered a source of root hair and vegetable matter.

Mycobacterial Brain Tuberculomas due to Bacille Calmette‐Guérin Intravesical Chemotherapy for Bladder Cancer: A Case Report and Literature Review

Bacille Calmette-Guérin (BCG) immunotherapy is widely used for the treatment of superficial bladder cancer. The authors believe that the present report is one of the first to document cerebral BCG tuberculoma in a 73-year-old immunocompetent man, three years after intra-vesical BCG immunotherapy. His workup revealed no identifiable extracranial source. He responded well to treatment with rifampin, ethambutol and moxifloxacin.Patients undergoing intravesical BCG therapy should be closely monitored for the development of this complication. Prolonged antitubercular therapy, possibly including moxifloxacin, appears to be beneficial in the treatment of central nervous system tuberculous infections.

Febrile Brain Stroke and Tuberculous Meningitis: Persisting Threat in Non-Endemic Countries

Tuberculous meningitis is uncommon in western countries and its outcome is poor when it is not diagnosed and treated in good time. Here, we present a case of febrile brain stroke revealing a tuberculous arachnoiditis in a 13-month-old infant living in a non-endemic country. Thanks to prompt specific antibiotherapy, the clinical outcome was globally favourable in spite of the occurrence of an asymptomatic brain tuberculoma, which disappeared spontaneously. Although tuberculous meningitis is rare in non-endemic countries, it must be evoked in strokes occurring in a febrile context.

Simultaneous scrofuloderma and intracranial tuberculomas: A rare presentation of systemic tuberculosis

Tuberculosis can involve multiple organ systems concurrently. We report a case of simultaneous brain tuberculomas and scrofuloderma occurring in the same patient. Skin biopsies confirmed scrofuloderma and the patient was successfully treated for tuberculosis with resolution of the brain masses. This case illustrates the importance of dermatological manifestations of systemic disease as an accessible source for diagnosis and guidance in appropriate therapy.

P02-218 - Case report of cerebellum tuberculosis in 40 years old male in Ardabil

BackgroundTuberculoma occurs in all age groups but are encountered most often during the first three decades of life. Recognized extra cranial infection or a history of exposure to tubercle bacilli are common but not constant feature.MethodMicroscopically, the process of caseation culminates centerally as a core of amorphous eosinophilic substance but remains imperfect peripherally as a basophilic band of karyorrhectic debris. It is in this outer zone that tubercle bacilli are to be found in greatest abundance. The firm lamina that surrounds the caseous component consists of chronically inflamed fibrous tissue, scattered islands of lymphoid cells, granulomas & giant cells. Polymorphonuclear leukocytes predominate in some lesion. The paucity of granulomatous inflammation in rare lesions produces a similarity to the more common pyogenic abscess. Granulomatous forms of cerebritis also are seen in other mycobacterial & fungal infections, parasitic or spirochetal infection, and in idiopathic condition such as sarcoidosis, crohn disease, SLE. The only way to establish a definitive diagnosis is by biopsy.ResultsSigns & symptoms as headache, seizures, papilledema, hemiplegia, and cerebellar dysfunction are expressions of the lesion's destructive & expansile nature. Fever may intimate its inflammatory character. In situ the Tuberculoma is remarkable for the contrast between its hard consistency & that of juxtaposed edematous brain.DiscussionAlthough, social & economic development lessen the incidence of brain tuberculomas, it might be a matter for the neurosurgeon which must be differentiated from abscess.