title: Solitary tuberculous brain lesions: 24 new cases and a review of the literature.
abstract: A solitary tuberculous brain lesion (STBL) can be difficult to distinguish from a glioma, metastasis or other infectious disease, especially from a pyogenic brain abscess. We analyzed the clinical characteristics, diagnostic procedures and outcomes of 24 patients with STBL diagnosed in three centers from France, India and Mexico. We also reviewed 92 STBL cases previously reported in the literature. General symptoms were found in 54% of our patients, including enlarged lymph nodes in 20%. Cerebrospinal fluid was typically abnormal, with lymphocytic pleocytosis and a high protein level. The lung CT scan was abnormal in 56% of patients, showing lymphadenopathy or pachipleuritis. Brain MRI or CT was always abnormal, showing contrast-enhanced lesions. Typically, MRI abnormalities were hypointense on T1-weighted sequences, while T2-weighted sequences showed both a peripheral hypersignal and a central hyposignal. The diagnosis was documented microbiologically or supported histologically in 71% of cases. Clinical outcome was good in 83% of cases.
authors.affiliation: Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France. Electronic address: dimitri.psimaras@psl.aphp.fr.
authors.forename: D
authors.initials: D
authors.lastname: Psimaras
authors.affiliation: Department of Neurology, Charles University in Prague, 1st Faculty of Medicine and General Teaching Hospital, Kateřinská 32, 121 08 Praha 2, Czech Republic.
authors.forename: C
authors.initials: C
authors.lastname: Bonnet
authors.affiliation: Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
authors.forename: A
authors.initials: A
authors.lastname: Heinzmann
authors.affiliation: Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Av Insurgentes Sur 3877, La Fama, Tlalpan, 14269 Ciudad de Mexico, Distrito Federal, Mexico.
authors.forename: G
authors.initials: G
authors.lastname: Cárdenas
authors.affiliation: Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Av Insurgentes Sur 3877, La Fama, Tlalpan, 14269 Ciudad de Mexico, Distrito Federal, Mexico.
authors.forename: S
authors.initials: S
authors.lastname: Hernández José Luis
authors.affiliation: Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Rd, Sector 1, Vrindavan Yojna, Lucknow, Uttar Pradesh 226014, India.
authors.forename: A
authors.initials: A
authors.lastname: Tungaria
authors.affiliation: Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Rd, Sector 1, Vrindavan Yojna, Lucknow, Uttar Pradesh 226014, India.
authors.forename: S
authors.initials: S
authors.lastname: Behari
authors.affiliation: Service de Neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
authors.forename: D
authors.initials: D
authors.lastname: Lacrois
authors.affiliation: Service d'Anatomopathologie, Groupe Hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
authors.forename: K
authors.initials: K
authors.lastname: Mokhtari
authors.affiliation: Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
authors.forename: E
authors.initials: E
authors.lastname: Karantoni
authors.affiliation: Department of Medicine, Faculty of Medicine University of Khartoum, Gamma Ave, Khartoum 11111, Sudan.
authors.forename: E
authors.initials: E
authors.lastname: Sokrab Tag
authors.affiliation: Department of Neurology, Hamad General Hospital, Doha, Qatar.
authors.forename: N
authors.initials: N
authors.lastname: Idris Mohamed
authors.affiliation: Department of Radiology, GATA Haydarpasa Teaching Hospital, Radyoloji Böl., 81327 Uskudar/Istanbul, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Sönmez
authors.affiliation: Department of Infectious and Tropical diseases, Hôpital Pitié-Salpêtrière, University Pierre-et-Marie-Curie, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
authors.forename: E
authors.initials: E
authors.lastname: Caumes
authors.affiliation: Fédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, INSERM-UPMC UMRS 975-CRICM, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
authors.forename: E
authors.initials: E
authors.lastname: Roze
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000175:diagnosis; D001932:Brain Neoplasms / Q000175:diagnosis; D015897:Comorbidity; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000209:etiology; D005602:France / Q000453:epidemiology; D005910:Glioma / Q000175:diagnosis; D006261:Headache / Q000209:etiology; D006801:Humans; D007194:India / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009018:Morocco / Q000208:ethnology; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D063189:Symptom Assessment; D014057:Tomography, X-Ray Computed; D016862:Tuberculoma, Intracranial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Abcès cérébral; Biopsie cérébrale; Brain abscess; Brain tuberculosis; Cerebral biopsy; Glioma; Gliome; Imagerie par résonance magnétique; Magnetic resonance imaging; Tuberculoma; Tuberculome; Tuberculose cérébrale