[Focal dystonia and tremor secondary to brain stem tuberculoma].
Brainstem tuberculoma is exceptionally observed. We report a 44 year-old immunocompetent man with proven diagnosis of miliary tuberculosis (TBC) who developed a complex neurological syndrome characterized by right ophtalmoplegia, left-sided hemiparesis and hemihypoesthesia and a gross ipsilateral postural and action tremor with hand dystonia. A ponto-mesencephalic mass was detected by CT and MRI studies of the brain. Clinical, bacteriological and neuroimaging studies allowed to suspect a ponto-mesencephalic tuberculoma. Long-term therapy with anti-TBC drugs and steroids was started, achieving clinical and imaging improvement which retrospectively confirmed the diagnosis. Although with less amplitude, tremor persisted but a complete disappearance of focal dystonia was observed. The pathogenesis of both abnormal movements is particularly discussed since hand dystonia has never been mentioned in the literature as a consequence of brainstem damage.
Winkel
M
M
División de Clínica Médica B y Unidad de Neurología, Hospital Juan A. Fernández, Buenos Aires, Argentina.
Pagano
M A
MA
Allievi
A
A
Kartin
D
D
Lera
G
G
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D001933:Brain Stem / Q000473:pathology*; D004421:Dystonia / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013256:Steroids; D014202:Tremor / Q000209:etiology*; D014375:Tuberculoma / Q000150:complications* / Q000188:drug therapy / Q000473:pathology*; D014391:Tuberculosis, Miliary / Q000150:complications / Q000188:drug therapy
D000893:Anti-Inflammatory Agents; D000995:Antitubercular Agents; D013256:Steroids
Distonía focal y temblor secundarios a tuberculoma del tronco encefálico.