[Tuberculoma and tuberculous meningitis mimicking metastatic brain tumor and meningeal carcinomatosis--case report].
A 45-year-old man was well until February 1986, when he experienced gait disturbance and psychiatric symptoms. On February 11 he fell down several times and developed generalized convulsion on the following day. He was admitted to a hospital in a delirious condition. The chest X-ray film showed infiltration in the left upper lobe, but computed tomographic (CT) scan of the head revealed no abnormality. Cerebrospinal fluid obtained by lumbar puncture contained 155 cells/mm3, all of which were lymphocytes, and protein and glucose concentrations were 372 mg/dl and 68 mg/dl respectively. In spite of negative smear tests of sputum and cerebrospinal fluid for tubercle bacilli he was administered antituberculosis drugs on the suspicion of pulmonary tuberculosis and tuberculous meningitis. His level of consciousness gradually returned to normal but the follow-up CT scans showed a low density area with contrast enhancement in the right thalamus and obliteration of the right quadrigeminal cistern which was also enhanced with contrast medium. He was transferred to our hospital on March 28 for further evaluation. On admission to our hospital he was alert and oriented, his pupils were equal and reactive to light and he had mild left hemiparesis, left hyperreflexia and left hemihypesthesia. Cell count of the cerebrospinal fluid was 243/mm3, 90% of which were lymphocytes and protein and glucose contents were 340 mg/dl and 42 mg/dl respectively. Both smear and culture of the cerebrospinal fluid were negative for tubercle bacilli and other organisms. Cytological examination of the cerebrospinal fluid demonstrated clusters of cells of various sizes with high N/C ratio which suggested these cells were malignant.(ABSTRACT TRUNCATED AT 250 WORDS)
Morimoto
T
T
Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan.
Sasaki
T
T
Basugi
N
N
Nagayama
I
I
Umemura
H
H
D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D006801:Humans; D008297:Male; D008581:Meningitis / Q000175:diagnosis*; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014375:Tuberculoma / Q000175:diagnosis* / Q000473:pathology; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000473:pathology