Tumour-like presentation of central nervous system tuberculosis: a retrospective study in Kingdom of Saudi Arabia

ABSTRACT

To differentiate the tumour-like presentation of central nervous system [CNS] tuberculosis [TB] from CNS tumours. We conducted a retrospective chart review of all cases of CNS TB seen at King Abdulaziz Medical City, Jeddah, between January 2002 and January 2012. No symptoms or signs of pulmonary or systemic TB were found. Of the 125 patients with CNS TB, 9 [7.2%] presented with clinical and radiological features suggestive of a brain tumour. A diagnosis of tuberculoma was established either intraoperatively in frozen sections [three patients] or postoperatively when the masses were resected [six patients]. After surgery, seven patients recovered after receiving anti-TB treatment; one patient died, and another developed a severe neurological deficit. CNS TB is a great mimicker of brain tumours, and the index of suspicion should be high, especially in endemic areas. A diagnosis is based on clinical presentation and the results of investigations. In patients with CNS TB that present with a mass lesion, a biopsy should be taken to avoid morbidity and mortality from an unnecessary surgical intervention. Greater use should be made of magnetic resonance spectroscopy in the evaluation of brain space-occupying lesions, and CNS TB should be included in the differential diagnosis of such lesions in all areas endemic for TB. The absence of constitutional or pulmonary symptoms of TB is deceiving. More nationwide epidemiological studies are needed to establish guidelines for early detection and successful outcomes of this rising health problem: