Left Parietal Lobe Tuberculoma in an Immunocompromised Patient Diagnosed in Europe
Abstract
Goncalo Januario
Tuberculomas are intracranial manifestations of tuberculosis. In endemic regions they account for a third of intracranial lesions. In patients without signs of meningitis, clinical features are indistinguishable from any other intracranial lesions. Neuroimaging can present various patterns, which can be identified on computed tomography (CT) scan and magnetic resonance imaging (MRI). Each pattern has characteristic MRI appearances and differential diagnoses on imaging.
We present a case of central nervous system tuberculosis (CNS TB) in an immunoincompetent host who presented new-onset seizures, a 46-year-old woman who complained of headache and consciousness disturbance. Brain CT and MRI showed lesion in left parietal lobe, ring enhancement, with mass effect and edema.
A left parietal craniotomy with total resection of the lesion was performed, without complicati- ons associated with the procedure. Histopathological study was suggestive of tuberculoma with multifocal granulomas, caseous necrosis and Langerhans giant cells. Early diagnosis and treatment can be lifesaving. Even, in developed countries the diagnosis is difficult and frequently delayed or missed. Histopathology is required for a definitive diagnosis. Prompt surgical resection and decompression if necessary with adequate antitubercular treat- ment yield better neurological outcomes. The type and the duration of the treatment depend on age, general state of health, possible resistance to the medicines and the location of the infection in the body.