Atypical imaging findings in a case of intracranial tuberculoma

  • Akhil Patil Assistant Professor, Department of Radiology, SN Medical College, Bagalkot
  • Rudresh S. Halawar Associate Professor, Department of Radiology, SN Medical College, Bagalkot, India
  • Ravi Badagandi Senior Resident, Department of Radiology, SN Medical College, Bagalkot
  • Manaswini Pol Senior Resident, Department of Radiology, SN Medical College, Bagalkot,
  • Paragouda Patil Senior Resident, Department of Radiology, SN Medical College, Bagalkot,
  • Shantala H. R. Senior Resident, Department of Radiology, SN Medical College, Bagalkot,
Keywords: Tuberculoma, Glial tumor, Antituberculoma therapy

Abstract

Tuberculosis is a major public health problem in developing nations like India. Tuberculosis of the central nervous system is not uncommon. Meningitis and tuberculoma are the two most important manifestations of tuberculosis of the CNS. Intracranial tuberculomas can present as solitary lesion or multiple lesions. Many atypical radiological findings of tuberculomas are known. They may be indistinguishable from cranial abscess or primary brain tumour. In India, tuberculoma should be considered as a differential in patients with intracranial mass lesions. We present a case of intracranial tuberculoma mimicking a high grade gliomas on magnetic resonance imaging and clinical presentation. A 58-year-old male presented with one-month history of epilepsy. Cranial magnetic resonance imaging showed a in right gangliocapsular region peripheral ring-enhancing lesions with central necrosis and one of the lesion showing thick wall enhancement and highly raised choline/creatinine rat. There was a strong suspicion of glial tumour. On CSF studies of the patient, 100% lymphocytes were noted and no malignant cells were seen. The patient was treated with antituberculous chemotherapy.

Downloads

Download data is not yet available.

References

. Blackwood W et al (eds): Greenfields Neuropathology, 2nd edn. Baltimore: Williams & Wilkins, 1963

. Brismar J, Hugosson C, Larsson SG, Lundstedt C, Nyman R: Imaging of tuberculosis -Tuberculosis as a mimicker of brain tumour. Acta Radiol 1996; 37: 496-505.

. Danziger J, Bloch S, Cremin BJ, Goldblatt M: Cranial and intracranial tuberculosis. S Afr Med J 1976; 50:1403-1405.

. Del Brutto OH, Mosquera A: Brainstem tuberculoma mimicking glioma: The role of antituberculous drugs as a diagnostic tool. Neurology 1999; 52:210-211.

. Garg RK: Tuberculosis of the central nervous system postgrad. Med J 1999; 75:133-140.

. Gupta RK, Vatsal DK, Husain N, Chawla S, Prasad KN, Roy R, Kumar R, Jha D, Husain M: Differentiation of tuberculous from pyogenic brain abscesses with in vivo proton MR spectroscopy and magnetization transfer MR imaging. Am J Neuroradiol 2001; 22: 1503-1509.

. Jinkins JR: Computed tomography of intracranial tuberculosis. Neuroradiology 1991; 33:126-135.

. Pretell EJ, Martinot C Jr, Garcia HH, Alvarado M, Bustos JA, Martinot C: Cysticercosis working group in Peru. Differential diagnosis between cerebral tuberculosis and neurocysticercosis by magnetic resonance spectroscopy. J Comput Assit Tomogr 2005; 29:112-114.

. Singh KK, Nair MD, Radhakrishnan K, Tyagi JS: Utility of PCR Assay in diagnosis of en-plaque tuberculoma of the brain. J of Clin Microbiology 1999; 37:467-470.

. Yanardag H, Uygun S, Yumruk V, Caner M, Canbaz B: Cerebral tuberculosis mimicking intracranial tumour. Singapore Med J 2005. 46:731-733.

. Whiteman ML: Neuroimaging of central nervous system tuberculosis in HIV-infected patients. Neuroimaging Clin N Am 1997; 7: 199-214.

Published
2017-11-30
Section
Case Report