Brainstem tuberculoma in the immunocompetent: case report and literature review.
Brainstem tuberculoma is an uncommon entity especially in the immunocompetent adult. The authors describe the case of a 32-year-old immunocompetent woman with no systemic signs or symptoms of tuberculosis, presenting with sudden-onset hemiparesis and diplopia. MRI of brain revealed an enhancing lesion in the midbrain and thalamus. Cerebrospinal fluid examination was normal. Chest imaging was consistent with miliary tuberculosis; however initial expectorated sputum was culture negative. Bronchosopy sputum culture was positive for Mycobacterium tuberculosis. Her PPD was negative. Patient became asymptomatic with treatment for tuberculosis and follow-up MRI showed complete resolution of the lesion a year later. We conclude that a high index of suspicion is essential to make an early diagnosis of intracranial tuberculoma, since often, traditional TB tests like PPD and sputum examinations can be negative.
Sahaiu-Srivastava
Soma
S
Department of Neurology, University of Southern California, Los Angeles, United States. sahai@usc.edu
Jones
Brenda
B
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001933:Brain Stem / Q000473:pathology*; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D007121:Immunocompetence; D008279:Magnetic Resonance Imaging; D013183:Sputum / Q000382:microbiology; D013681:Tegmentum Mesencephali / Q000473:pathology; D013788:Thalamus / Q000473:pathology; D014374:Tuberculin Test; D016862:Tuberculoma, Intracranial / Q000188:drug therapy / Q000473:pathology*; D014391:Tuberculosis, Miliary / Q000150:complications / Q000473:pathology
D000995:Antitubercular Agents