A study of clinical profile and treatment outcomes in CNS tuberculoma

Worldwide, around 10 million people fall sick every year because of Tuberculosis (TB). In India, the incidence is 2.69 million cases. Central nervous system Tuberculosis (CNS TB), which is one of the most deadly forms of tuberculosis (TB) mainly manifests as TB Meningitis followed by Tuberculoma, Tubercular abscess and other forms. CNS TB is seen in 5 to 10% of extra-pulmonary TB cases, and accounts for 1% of all TB cases and has the highest mortality. They usually present with symptoms such as headache and seizures. They may have other signs and symptoms based on the size and the location of the lesions. The advent of modern technology such as CT, MRI scans helped to diagnose early. Diagnosis is established by CT/MRI Brain, where a granulomatous lesion with/without perilesional edema is seen. MR Spectroscopy brain is indicated when the diagnosis is doubtful. Presence of lipid peak on MR Spectroscopy is diagnostic of CNS Tuberculomas. Medical management is adequate and there is no role for surgery. A course of ATT for 6 months along with corticosteroids is adequate. Addition of corticosteroids is necessary to reduce the paradoxical response; it also reduces the size of the lesion and perilesional edema. Anti epileptic drugs are not necessary. CNS Tuberculoma is curable if treated properly.

A clinical study of CNS Tuberculomas

Thirty cases of CNS Tuberculomas were studied as suggested by the CT Scan Brain (Plain and Contrast) from 2007 to 2009, at Gandhi Medical College, Hyderabad, India. It was most common in second and third decade of life. The most common clinical presentation was convulsions. Routine investigations did not yield the diagnosis of tuberculosis. All patients were treated with Anti Tuberculous Treatment (ATT), for 6 months and oral steroids. ATT consisted of 2 months of intensive phase of HRZE and 4 months of continuation phase of HR. No surgical intervention was done. After completion of chemotherapy, they were followed up for 6 months. Repeat CT Scans were done, which showed clearance of all tuberculomas.

Opthalmic manifestations of central nervous system tuberculosis - Two case reports.

Sumrnury: In this report, we present two unusual ocular manifestations due to CNS tuberculosis. One of the cases is a 7 years old boy with brain stem tuberculoma who presented with horizontal gaze palsy. The other is a 14 years old girl with temporal lobe tuberculoma who presented with unilateral sixth nerve paresis and papilledema. Both responded well to treatment with antitubercular drugs. It highlights the importance of gaze palsy as a rare manifestation of CNS tuberculosis.