Tuberculoma brain: diagnostic criteria and conservative management

ABSTRACT

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