Prognostic indicators in patients with intracranial tuberculoma: a review of 102 cases

To see the characteristics, course and outcome of patients suffering from intracranial tuberculoma. Retrospective review of 102 patients diagnosed as intracranial tuberculoma at a tertiary care center over 10 years. A total of 102 cases were seen with an age range of 1 to 75 years [mean, 30 years]. Predisposing factors included Diabetes mellitus [8 patients] and pregnancy or puerperium [7 patients]. Five pediatric patients had tuberculoma despite documented BCG vaccination. Fever [59%], headache [57%], meningeal irritation [36%] were the commonest presenting features; one-third of patients were drowsy or comatosed at presentation. Cerebrospinal fluid analysis was performed in 63 patients, of whom 88% had elevated protein, 83% had low glucose, and 84% had pleocytosis [one-third with neutrophilia]. Forty-nine [50%] patients had clinical or laboratory evidence of concomitant tuberculous meningitis, Chest radiographs showed active or old tuberculous infection [25%], with a miliary pattern in 20%. Two-thirds of subjects had multiple tuberculomas [mean, 4.5 lesions per patient] on contrast CT or MRI scan. Hydrocephalus was present in 37 [37%] patients of which 21 required shunt surgery. Thirty-nine patients had > 9 months of follow up; 17 patients showed complete recovery, 20 patients had partial recovery, and 2 patients had no response. Coma at presentation and miliary pattern on chest X-ray were predictors of poor prognosis. The study demonstrate that fever, headache, signs of meningeal irritation and cranial nerve palsies are common presenting features. Complete recovery was seen in 40% patients. Coma and military TB are predictors of poor prognosis