A rare cause of postpartum seizure: Cerebral tuberculoma.

Tuberculomas are rare and a life-threatening condition. Diagnosis followed by appropriate treatment can lead to complete resolution of the disease. A suggestive imaging study in an appropriate clinical setting can lead to the diagnosis. We describe a case of a postpartum woman with a headache and seizure in which eclampsia was the initial suspicion. Imaging exams demonstrated a solitary expansile lesion in the left parietal lobe suspicious of neoplasia. A biopsy, instead, confirmed a tuberculoma. In addition to eclampsia, many other differential diagnoses are possible in the context of seizures in pregnant and peripartum patients, including central nervous system tuberculosis. Brain imaging studies can be crucial in the diagnostic process.

Cerebral tuberculoma and convulsion in infants: A case report.

Tuberculosis of the central nervous system is the second most common site after tuberculous meningitis. It represents 0.2% of intracranial expansive lesions in some Western countries compared to 10%-30% in developing countries. We report the case of an infant of 1 year and 2 months old who presented for 15 days with convulsions with asthenia, hypotonia, without fever. The clinical examination and laboratory workup were without abnormalities. His father had ongoing pulmonary tuberculosis, but the infant had no clinical or radiological signs of pulmonary tuberculosis. A brain MRI was showed multiple punctiform brain lesions, suggesting intracerebral tuberculomas in the first place, given the clinical and radiological appearance and the father's history of tuberculosis. The patient was put on anti-convulsant and antibacillary treatment. Through this case, we can see the clinical and radiological polymorphism of cerebral tuberculoma. The diagnosis of certainty remains anatomopathological. The prognosis is poor when it is detected late.

Cerebral Tuberculoma Diagnosed by Nested Polymerase Chain Reaction of a Formalin-fixed Paraffin-embedded Brain Biopsy Sample.

A 38-year-old man was taken to hospital with generalized clonic seizure. Brain magnetic resonance imaging (MRI) showed multiple ring-enhancing lesions centered in the left frontoparietal lobe. A histopathological examination of a brain biopsy sample revealed granulomatous lesions with caseous necrosis. We extracted DNA from a formalin-fixed paraffin-embedded (FFPE) brain specimen, and nested polymerase chain reaction (PCR) of the DNA sample detected the Mycobacterium tuberculosis-specific insertion sequence IS6110. The lesions worsened after anti-tuberculosis drugs were administered, which we considered to be a paradoxical response and continued treatment. A genetic diagnosis of M. tuberculosis using FFPE specimens is useful for diagnosing tuberculoma.

A 73-year-old man with loss of consciousness during treatment for miliary tuberculosis.

Miliary tuberculosis is often associated with cerebral tuberculoma, which can manifest during treatment. We present images of a patient with cerebral tuberculoma detected due to emerging neurological symptoms during treatment of miliary tuberculosis.

Cerebral Tuberculoma with Mild Posterior Cervical Pain as the Main Symptom Despite Extensive Brain Lesions.

A 59-year-old woman with a diabetes history experienced mild neck pain. A neurological examination revealed only mild neck stiffness. Magnetic resonance imaging showed extensive T2-weighted high-intensity lesions with patchy gadolinium enhancement mainly involving the white matter in the right parietal lobe. A cerebrospinal fluid analysis revealed increased protein levels and pleocytosis. While QuantiFERON-TB Gold was positive, computed tomography (CT) and fluorodeoxyglucose on positron emission tomography-CT of the whole body showed no abnormal accumulation, suggesting tuberculosis. A brain biopsy revealed cerebral tuberculoma. As cerebral tuberculoma can show minimal neurological symptoms despite extensive lesions, a cautious examination and early treatment are required to prevent a devastating prognosis.

Diagnosis and management of intracranial tuberculomas: about 2 cases and a review of the literature.

Central nervous system tuberculosis is a major cause of morbidity and mortality in developing countries. Intracranial tuberculoma is rare and is one of the most severe cases of tuberculosis. We present two cases. The first one is about a girl of 7 years, followed for 5 months for lymph nodes tuberculosis on anti-TB treatment that presents generalized tonic-clonic seizures associated with progressive intracranial hypertension syndrome. Brain MRI has objectified necrotic nodules in left hemisphere. The surgical approach of the lesions was direct with complete excision. The diagnosis of tuberculoma was confirmed by anatomopathological examination. The second case is about a 6-year-old girl with no particular medical history, which presents for three months progressive and treatment-resistant cervico-occipital headaches associated with walking difficulties. The MRI objectified left cerebellar tumor process interpreted preoperatively as medulloblastoma. The patient was operated on intraoperative, appearance was that of a nodular lesion. Anatomopathological examination confirmed the diagnosis. The intracranial tuberculoma is an unusual variety of the central nervous system tuberculosis and remains a topical issue in Morocco. The prognosis depends on prompt diagnosis, quality of surgical resection and anti-TB treatment. The diagnostic confirmation is histological and should therefore be evoked infront of any intracranial process mimicking a brain tumor.

[Cerebral tuberculoma a diagnostic challenge: case study and update]. / Tuberculome cérébral un challenge diagnostic: à propos d'un cas et mise au point.

Central nervous system (CNS) tuberculosis is the second most common presentation after tuberculous meningitis. It is a major cause of morbidity and mortality in the developing countries, accounting for 10-30% of intracranial expansive lesions in these countries against 0.2% in some Western countries. This study aims to report an atypical clinical and radiological manifestation (brain MRI and spectroscopy) of cerebral tuberculoma in order to provide an update on this infectious disease. The study involved a 44-year old female patient with no particular previous history, with headaches persisting for 1 year and complicated by partial secondarily generalized seizures and heaviness at the left hemicorpus with episodes of vomiting without visual disorder or fever or deterioration of general condition after 8 months. Clinical examination showed conscious patient with Glasgow Coma Scale (GCS) 15, equal and reactive pupils, walking and/or standing without fault, with 4/5 left-sided hemiparesis without other neurological signs. Brain MRI objectified right parietal subtentorial plurilobulated isointense poorly differentiated lesion on T1 weighted sequence without contrast agents injection and heterogeneous lesion with hyperintense edge and hypointense fundus, suggesting fleshy process with areas of central necrosis and perilesionnal edema extending in finger-like fashion with intense annular enhancement after gadolinium injection on T2 weighted sequence. Spectroscopy showed glial tumor. The patient received anticonvulsant therapy and macroscopic complete resection. Anatomopathologic analysis showed cerebral tuberculoma. She received antituberculosis drugs with seizure stoppage and deficit recovery after 4 weeks. This study highlights the clinical and radiological polymorphism of cerebral tuberculoma. This is suspected based on laboratory tests as well as on a body of clinical and radiological evidences but definitive diagnosis is based on anatomopathologic analysis. Early management is essential because complications can be severe and result in a poor prognosis.

Audit of computed tomography brain findings in HIV-infected patients with space occupying infective lesions at a regional level hospital in KwaZulu-Natal.

BACKGROUND: With the increased prevalence of HIV pandemic, more focus is placed on pathology involving the central nervous system secondary to HIV infection. Medical computerised tomography scans have become an integral investigation at a regional hospital level. OBJECTIVE: To provide a description of central nervous system space occupying infective lesion found within this cohort of patients. SETTING: Edendale Hospital, Pietermaritzburg, KwaZulu-Natal. METHODS: This was a retrospective study in which the charts of all HIV-infected medical patients with findings of a space occupying infective lesion on computerised tomography brain seen for the time period 1 January 2015 up to and including 31 December 2015 were analysed. A total of 110 patient files were evaluated. RESULTS: Most patients were in the third to fourth decade of life with mean cluster of differentiation 4 of 125 cells/mm3. A differential comprising toxoplasmosis or tuberculoma (80.9%) was the leading aetiology described. Most frequent clinical features in these patients included seizures (41.8%), confusion or altered mental state (38.2%), headaches (33.6%), hemiparesis (48.2%) and cranial nerve abnormality (22.7%). The most common central nervous system sites involved were, in order of decreasing prevalence was parietal, basal ganglia, frontal cortex (31.8% vs 31.8% vs 26.4%, respectively). Early initiation of co-trimoxazole and anti-tuberculosis treatment yielded better outcomes compared to the group who received delayed or no treatment with p-values (Pearson's χ2) of 0.0002 and <0.0001, respectively. CONCLUSION: Computerised tomography scans to detect space-occupying infective lesion of the brain are invaluable for rapid diagnosis and to reduce morbidity and mortality.

[Intracranial tuberculomas in Nouakchott, Mauritania]. / Les tubérculomes intracrâniens à Nouakchott, Mauritanie.

Tuberculosis is a major public health problem in developing countries. Cerebral tuberculomas is a tuberculous granulation tissue mass restrained and limited by immune defenses of the host. This study aims to describe the characteristics and the evolutionary profile of intracranial tuberculomas in Mauritania. Data of 34 patients with intracranial tuberculoma were collected retrospectively in several hospitals in the city of Nouakchott between January 2005 and June 2017. Evolutionary features of patients under treatment were analyzed. Our retrospective study involved 20 men and 14 women (sex ratio 1.4). The average age of our patients was 28.7 years. Twelve patients were less than or equal to 16 years. Symptomatology was dominated by increased intracranial pressure and seizures in 27 cases (79.41%) and 20 cases (58.82%) respectively. Intradermo tuberculin reaction was positive in 14 (41.17%) cases. Supratentorial lesion was found in 24 patients (70.58%). In all patients, therapeutic approach was based on multidrug chemotherapy for a period greater than or equal to 12 months. Surgical procedure was performed in 12 patients (35.29%). Outcome was favorable with complete healing without sequelae in 23 cases, reflecting a rate of 67.64%. Given the non-specific role of imaging exams in the diagnosis of intracranial tuberculoma and the lack of the stereotactic biopsy in our Country where the disease is endemic, we recommend to perform a two-month therapeutic test in patients with suspicious lesions.

Intracranial Tuberculoma Presenting as Atypical Eclampsia: A Case Report.

Occurrence of eclampsia before 20 weeks of pregnancy and after 48 hours of delivery in the absence of typical signs of hypertension and or proteinuria is termed as atypical eclampsia. Atypical or non-classic eclampsia will have some symptoms of eclampsia but without the usual proteinuria or hypertension. All patients with atypical onset should undergo neurological evaluation to rule out neurologic causes of seizures. Cerebral tuberculosis is a rare and serious form of disease secondary to haematogenous spread of Mycobacterium tuberculosis. Here we present a case of cerebral tuberculoma with seizures in late pregnancy mimicking eclampsia.

Tuberculoma cerebral en paciente joven inmunocompetente / Cerebral tuberculoma in young immunocompetent patient

RESUMEN La tuberculosis con afección del sistema nervioso central es una afectación infrecuente pero muy grave de esta enfermedad, representa el 1% de todos los casos de tuberculosis. Reportamos el caso de una joven HIV negativa, con daño del sistema nervioso central de tipo miliar a nivel cerebral y sin enfermedad pulmonar. La tuberculosis puede afectar extensamente a sujetos inmunocompetentes y este fenómeno ha sido descripto en muchas series a los largo del tiempo. Ante la sospecha clínica, el seguimiento de un protocolo específico para confirmar el diagnóstico es de vital importancia para el temprano diagnóstico y correcto manejo de una situación que puede comprometer la vida y generar a largo plazo secuelas graves. Se presenta el caso por el reto diagnóstico que ha supuesto y rara presentación en paciente inmunocompetente.

ABSTRACT Tuberculosis with central nervous system involvement is an uncommon but very serious disease, with a frecuence of 1% of all cases of tuberculosis. We report the case of a young HIV negative woman, with central nervous system damage of the miliary type in the brain without lung disease. Tuberculosis can extensively affect immunecompetent subjects and this phenomenon has been described in many series over the time. In the presence of clinical suspicion, the follow-up of a specific protocol to confirm the diagnosis is of vital importance for the early diagnosis and correct management of a situation that can compromise life and generate long-term serious sequelae. The case is presented because of diagnostic challenge and a rare presentation in an immunocompetent patient.

Balo's Concentric Sclerosis Mimicking Cerebral Tuberculoma.

Balo's concentric sclerosis (BCS) is considered a rare variant of multiple sclerosis, which often mimics an intracranial neoplasm or abscess. We report the case of a 21-year-old woman presenting with BCS while undergoing treatment for pulmonary tuberculosis. Initial brain magnetic resonance imaging (MRI) findings were similar to those for cerebral tuberculoma, multiple metastases, or abscesses. However, the pathognomonic concentric sclerosis characteristic of BCS was seen on MRI. The antemortem confirmatory diagnosis of BCS was made by follow-up MRI and a brain biopsy. It is suggested that BCS should be included in the differential diagnosis of cerebral tuberculoma, especially in developing countries with a high prevalence of tuberculosis.

Balo's Concentric Sclerosis Mimicking Cerebral Tuberculoma

Balo's concentric sclerosis (BCS) is considered a rare variant of multiple sclerosis, which often mimics an intracranial neoplasm or abscess. We report the case of a 21-year-old woman presenting with BCS while undergoing treatment for pulmonary tuberculosis. Initial brain magnetic resonance imaging (MRI) findings were similar to those for cerebral tuberculoma, multiple metastases, or abscesses. However, the pathognomonic concentric sclerosis characteristic of BCS was seen on MRI. The antemortem confirmatory diagnosis of BCS was made by follow-up MRI and a brain biopsy. It is suggested that BCS should be included in the differential diagnosis of cerebral tuberculoma, especially in developing countries with a high prevalence of tuberculosis.

Mujer joven con convulsiones y nódulos pulmonares / Young woman with seizures and pulmonary nodules

RESUMEN Se presenta caso clínico de mujer joven con convulsiones, masa ocupante de espacio en cerebro y lesiones nodulares en pulmones. Se confirmó tuberculosis pulmonar por bacteriología y anatomía patológica. El tratamiento antituberculoso curó la afectación pulmonar también hizo remitir la lesión cerebral, confirmándose así un tuberculoma cerebral.

ABSTRACT We present a case of a young woman who presented with seizures, space-occupying mass nodular lesions in the brain and lungs. Pulmonary tuberculosis was confirmed with bacteriology and histopathology. Anti tuberculosis treatment cured lung lesions, also with remission of made forward brain lesion, confirming a tuberculoma of the brain.

Ring enhancing intracranial lesion responding to antituberculous treatment in an HIV-infected patient / Lesão intracraniana que respondeu ao tratamento anti-tuberculoso em paciente infectado pelo HIV

Cerebral tuberculomas constitute a major differential diagnosis of cerebral toxoplasmosis in human immunodeficiency virus (HIV)-infected patients in developing countries. We report the case of a 34-year old woman co-infected with HIV and possible disseminated tuberculosis (hepatitis, lymphadenopathy, and pleural effusion) who presented a large and solitary intracranial mass lesion. Despite extensive diagnostic efforts, including brain, ganglionar, and liver biopsies, no definitive diagnosis was reached. However, a trial with first-line antituberculous drugs led to a significant clinical and radiological improvement. Atypical presentations of cerebral tuberculomas should always be considered in the differential diagnosis of intracranial mass lesions in HIV-infected patients and a trial with antituberculous drugs is a valuable strategy to infer the diagnosis in a subset of patients.

Os tuberculomas cerebrais constituem diagnóstico diferencial importante da toxoplasmose cerebral em pacientes infectados pelo vírus da imunodeficiência humana (HIV) de países em desenvolvimento. Os autores relatam o caso de uma mulher HIV positiva de 34 anos de idade, que apresentou provável tuberculose disseminada (hepatite, adenomegalia, e derrame pleural) associada à lesão expansiva cerebral única e gigante. Apesar dos esforços diagnósticos realizados, incluindo biópsia cerebral, ganglionar e hepática, o diagnóstico etiológico não foi confirmado. Porém, a resposta clínico-radiológica ao tratamento tuberculostático permitiu definir o diagnóstico de tuberculoma cerebral e a paciente teve alta hospitalar. Apresentações atípicas de tuberculomas cerebrais devem ser sempre consideradas no diagnóstico diferencial das lesões expansivas cerebrais em pacientes infectados pelo HIV e o uso do tratamento tuberculostático constitui ferramenta útil na definição diagnóstica em um sub-grupo de pacientes.