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Central nervous system tuberculosis caused by Mycobacterium tuberculosis is the most severe form of tuberculosis, accounting for 1% of all TB cases. Intracranial tuberculosis can present as Tuberculous meningitis, Tuberculous encephalopathy, Tuberculous vasculitis, CNS tuberculomas and Tuberculous brain abscess. Here authors present a case of a 10-year-old girl who presented with insidious onset of early morning vomiting, excessive sleepiness with classical neuroimaging findings of intracranial tuberculosis. Authors emphasise that intracranial tuberculoma should be considered in the differential diagnosis of any intracranial space-occupying lesion with or without pulmonary involvement.
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Background: Despite the advent of newer antibiotics and surgical strategies, the overall outcome and quality of life issues in Brain Abscess (BA) patients remain a continuous challenge for the neurosurgical community.Methods: Fifty-six patients with BA are analyzed retrospectively, that treated between January 2014 and June 2019, according to age, the clinical symptoms, etiologic factors, infecting organisms, prognostic factors, localization, diagnostic and treatment methods and outcome.Results: In acute cases, common clinical features were headache, fever, vomiting, focal deficit and seizure. In chronic abscesses, common clinical features were mild to moderate headache and progressive focal deficit. In 12(21.42%) patients had adjacent localized sinus, middle ear infection. In 27(48.21%) patients no primary source of infection was identified, predisposing factors included post neurosurgery (8.92%), post penetrating injury (3.57%), and congenital heart disease, infective endocarditis, sinusitis. The frontal lobe involved in 28.5% cases, temporal lobe and cerebellum are next to be involved. Burr hole aspiration in 29(51.78%) cases, a craniotomy was done in 15(26.78%) cases. Pus culture was negative in 36 (64.28%) cases. Mortality was noted in 2(3.57%) cases. Complete resolution of the abscess with complete recovery of preoperative neuro-deficit was seen in 71.42% cases and recovery with major neuro-deficit was observed in 16.07% cases. The best outcome was seen with a better Glasgow Coma Scale (GCS) on admission.Conclusions: BA, when surgery is required, should be done on an emergency basis. BA treated with burr hole aspiration shows excellent clinical and radiological response. A craniotomy is required in selected cases and is a primary procedure in cerebellar, postoperative and posttraumatic abscesses. Broad-spectrum antibiotic therapy should be administered for a period of minimum 6 weeks to prevent relapse.
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Aim and objective:To study the role of MR spectroscopy in the evaluation and differential diagnosis of various ring enhancing lesions in the brain with multi-voxel proton MR spectroscopy. Materials and methods: It is the prospective observational study carried out on 42 patients from June 2016 to Aug 2018 at Department of Radiodiagnosis at AVBRH, DMIMS, Sawangi, Wardha. Appropriate MRI sequences with spectroscopy and multiplanar imaging has been performed on patients with intracranial ring enhancing lesions. Result and Conclusion: Total 42 patients were taken. Most common lesions seen were tuberculoma (38%) followed by brain metastasis (34%), neurocysticercosis (16%) and pyogenic brain abscess (12%). On MRS, Tuberculoma was differentiated from NCC by high Cho: Cr ratio > 1.1 and high lipid lactate peak. Special peaks like amino acids, acetate, aspartate and succinate were seen in pyogenic brain abcess while alanine and succinate were present in NCC. High choline peak and high Cho: Cr ratio were seen in brain metastases.
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We report a 4 year old girl with ring enhancing lesions in brain CT, initially diagnosed as neurocysticercosis but did not respond to cysticidal therapy. A Magnetic resonance spectropscopy (MRS) revealed lipid peaks suggestive of tuberculoma which was successfully treated with antituberculosis therapy. This report highlights the role of MRS in the diagnosis of ring enhancing lesios.