Tuberculoma brain: diagnostic criteria and conservative management

There is evidence that medically treated Tuberculoma patients have a significantly better functional recovery than those having surgical excision. This would not be possible theoretically unless strict diagnostic criteria are applied and if there is still doubt, resort to surgical excision or biopsy so that patient' health is not jeopardized. To evaluate the Effectiveness of Conservative management of Tuberculoma of Brain based on strict Diagnostic Criteria. Prospective Study. This study was conducted at Assir Central Hospital Abha KSA from March 2001 to August 2003. Out of total thirteen patients, Eight Patients presented with signs of raised intracranial tension [Headache, Vomiting], Two with localizing symptoms or signs [Hemiparesis and Diplopia], Two with history of Fever, Night sweats, Cough, and had been receiving immunosuppressive agents. One pregnant patient presented with history of convulsions on term. Three patients had Solitary and Ten patients Multiple Lesions. Maximum number of Lesions in our cases were Eleven and minimum was one. Patients were diagnosed based on Strict Criteria like Blood Smears, ESR, CRP, Acid-fast Bacillus in Sputum smears, CSF serology X-ray Chest, Contrast- enhanced CT and MRI. Failure of medical treatment occurred in two patient. One pregnant patient was operated due to intractable Epilepsy following caesarian section on term. The patients were followed for six months to Two years without recurrence. Diagnostic Criteria helped us to filter out TB Positive cases as against Bacterial, fungal and actinomycotic infections of brain. Conservative management alone was successful in the Treatment of Tuberculoma of Brain

Management of cerebral tuberculoma

Cerebral tuberculosis in developing countries is still a common disease, and there is an emergence of cerebral tuberculoma. Involvement of the brain by tuberculoma is a serious complication of cerebral tuberculosis and in rare cases an abscess or multiple tubercular abscesses may result. The management is controversial among the neurosurgical services which could be excision or stereotactic aspiration, or by conservative treatment with anti-tuberculous chemotherapy alone. Twenty-four patients with either histological confirmation of tuberculoma or classical radiological image appearance of the tuberculoma with complete structural disappearance of tuberculous lesion due to anti-tuberculous chemotherapy were reviewed retrospectively in the Neurosurgery Department, King Fahd Hospital of the University from June 1982 - June 1999. We tend to favour a surgical approach in cases with cystic lesion with marked cerebral compression or midline cerebral displacement either by stereotactic aspiration or excision alone. In addition, we also recommend conservative treatment when there is no evidence of clinical and/or radio-logical deterioration. The protocol for management of cerebral tuber-culoma is also discussed

Tuberculomas cerebrais / Cerebral tuberculomas

A tuberculose do sistema nervoso central é uma doença encontrada em todo o mundo, principalmente nos países subdesenvolvidos. No final do século passado, a incidência de tuberculomas era alta entre as lesoes expansivas intracranianas, mesmo em países desenvolvidos. Esta incidência caiu acentuadamente (de 30 para 3 por cento) na metade deste século, devido à introduçao da estreptomicina, e a tuberculose praticamente desapareceu nos países desenvolvidos nas décadas de 50 e 60. Posteriormente,casos esporádicos começaram a surgir, principalmente entre imigrantes. No Brasil, casos clínicos isolados de tuberculomas intracranianos têm sido descritos, mas eles constituem aproximadamente 5,5 por cento dos processos expansivos intracranianos observados em necrópsias. Neste trabalho, foram analisadas retrospectivamente as evoluçoes clínicas de sete pacientes portadores de tuberculomas cerebrais atendidos no Serviço de Neurocirurgia do HCFMRP, no período de 1979 a 1991. O diagnóstico de tuberculoma cerebral foi efetuado com base nos exames neuroradiológicos (radiografia simples e tomografia computadorizada), associados a antecedentes de meningite tuberculosa ou tuberculose extraneural, em cinco pacientes (três confirmados com exame histopatológico) e em dois, através do exame histopatológico da peça cirúrgica. Os sinais e sintomas mais freqüentemente observados foram os de hipertensao intracraniana e os de compressao/irritaçao do parênquima cerebral. Um paciente foi tratado apenas clinicamente com esquema tríplice (isoniazida, rifampicina e etambutol) e apresentou boa evoluçao. Três pacientes foram submetidos à exérese total ou subtotal da lesao e dois foram submetidos à exérese parcial da lesao e à DVP e um paciente foi submetido apenas à DVP. Para todos os pacientes, foi indicado tratamento com tuberculostáticos, embora um paciente nao o tenha completado. Os três pacientes que foram submetidos à exérese total da lesao, um dos pacientes submetidos à exérese parcial da lesao e à DVP e o paciente submetido apenas à DVP apresentaram boa evoluçao, com regressao e/ou calcificaçao das lesoes, com ou sem seqüelas neurológicas moderadas. O outro paciente submetido à ressecçao parcial e à DVP evoluiu mal e faleceu. Para os pacientes com tuberculomas intracranianos, indicamos inicialmente o tratamento clínico; o tratamento cirúrgico é indicado quando há hidrocefalia com hipertensao intracraniana, quando a lesao exerce efeito de massa importante, quando nao há resposta ao tratamento clínico ou quando há dúvida quanto ao diagnóstico.

Tuberculoma cerebral: manejo médico / Cerebral tuberculoma:medical management

Se reporta dos casos clínicos de Tuberculoma Cerebral tratados con quimioterapia antituberculosa asociada a corticosteroides, obteniéndose remisión completa de la sintomatología en ambos pacientes y resolución tomográfica en la paciente a quien se realizó dicho control. Se revisa los aspectos, métodos diagnósticos y tratamiento.