title: Isolated brainstem tuberculomas.
abstract: Isolated brainstem tuberculomas are rare lesions and account for up to 5% of all intracranial tuberculomas in endemic areas. The difficulties in diagnosis and management of this condition are sparsely reported. The aim of this study is to illustrate the nuances in managing brainstem tuberculomas, define prognosis, and demonstrate a shift in management strategies with newer imaging modalities.
  
  
  
  A retrospective review of 14 patients diagnosed and treated with a diagnosis of 'isolated brainstem tuberculoma' between 2011 and 2015 was done. Diagnosis was made after combining the findings at clinical history, examination, as well as imaging features. Patients were treated with steroids for 6 weeks or until they made a meaningful clinical recovery, and antitubercular therapy (ATT) for a minimum of 18 months or until there was resolution of the tuberculoma. Confirmation of tubercular pathology was done by observing if response to treatment resulted in clinical improvement, which happened in all of our cases.
  
  
  
  Mean age at diagnosis was 24.7 years and nine were males. Twelve patients had a combination of cranial nerve deficits with pyramidal weakness or sensory symptoms. Mean duration of symptoms was 4.7 months and tests for human immunodeficiency virus (HIV) infection were negative in all patients. Only two patients had a previous history of tubercular meningitis. Most lesions were located in the pons with size ranging from 1 to 22.2 cm3. Eight patients showed complete resolution of the lesion at latest follow-up and the rest were still on ATT. Mean duration of ATT received for resolution of the lesion was 22 months. Almost all of our patients improved clinically on steroids and ATT.
  
  
  
  Intracranial tuberculomas may present with or without meningitis. A high index of suspicion is essential, especially in endemic areas. A combination of clinical symptoms, investigations, and imaging features help in coming to a diagnosis. Biopsy of a brainstem lesion is fraught with complications. Antitubercular therapy has a very good prognosis, though the duration of therapy required may be longer.
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 2nd Floor, Neurosciences Faculty Building, Bangalore, 560029, India.
authors.forename: Nishanth
authors.initials: N
authors.lastname: Sadashiva
authors.affiliation: Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: Sarbesh
authors.initials: S
authors.lastname: Tiwari
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 2nd Floor, Neurosciences Faculty Building, Bangalore, 560029, India.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Shukla
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 2nd Floor, Neurosciences Faculty Building, Bangalore, 560029, India.
authors.forename: Dhananjaya
authors.initials: D
authors.lastname: Bhat
authors.affiliation: Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: Jitender
authors.initials: J
authors.lastname: Saini
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 2nd Floor, Neurosciences Faculty Building, Bangalore, 560029, India.
authors.forename: Sampath
authors.initials: S
authors.lastname: Somanna
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 2nd Floor, Neurosciences Faculty Building, Bangalore, 560029, India. bidevidr@gmail.com.
authors.forename: Bhagavatula Indira
authors.initials: BI
authors.lastname: Devi
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011149:Pons / Q000000981:diagnostic imaging / Q000473:pathology; D016862:Tuberculoma, Intracranial / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D014390:Tuberculosis, Meningeal / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents
keywords: Antitubercular therapy; Brainstem cysticercosis; Brainstem tuberculosis; Isolated brainstem tuberculoma; Tuberculoma