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Results for “Tuberculoma, Intracranial”

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PubMed1992

[Intracranial tuberculoma].

Intracranial tuberculoma is one of the most serious complication of tuberculosis. It generally accompanies tuberculous meningitis. Diagnosis is difficult. Computed tomography (CT) has greatly influenced the diagnosis and management. In this study, clinical and laboratory findings of three patients with intracranial tuberculoma were discussed. In CT study, intracranial tuberculomas were located at the level of brain stem in two patients and thalamic region in one patient. Although intracranial tuberculoma is uncommon in children, it must be included in the differential diagnosis of all tuberculous meningitis. This is especially important for the patients who have no BCG vaccination.

Brain Stem↗

PubMed1981

Intracranial tuberculoma.

Intracranial tuberculoma was studied by computed tomography (CT) in eight patients. Upon contrast enhancement, two patterns were seen: (a) a small enhancing ring with a central punctate lucent area, and (b) nodular enhancement. The various CT findings are correlated with the clinical features and with the appearance on radionuclide brain scanning and angiography.

Adult↗

PubMed1978

Recent cases of intracranial tuberculomas.

While intracranial tuberculomas have become uncommon in industrial nations, 12 patients with signs and symptoms of an intracranial mass lesion were recently found to have tuberculomas. Clinical findings suggestive of tuberculosis were frequently subtle or absent. Five patients did not have extracranial tuberculosis. Two patients had intracranial tuberculomas that became superinfected with bacteria and appeared initially as pyogenic brain abscesses. Intracranial tuberculomas in this country almost always occur in adults and represent reactivation of dormant infection. Medical therapy alone is indicated as the initial therapy except in the presence of intolerably increased intracranial pressure. A chemotherapeutic regimen is suggested.

Adult↗

PubMedDate not supplied

Multiple intracranial tuberculomas in a child.

Intracranial tuberculomas continue to be a serious complication of central nervous system tuberculosis. Tuberculomas are conglomerates of tubercles resulting from hematogenous spread of infection. Modern neuroimaging studies such as magnetic resonance imaging and molecular biologic techniques such as polymerase chain reaction are helpful in the diagnosis of central nervous system tuberculosis and tuberculomas. We report a boy with multiple intracranial tuberculomas diagnosed and treated with the aids of magnetic resonance and polymerase chain reaction techniques.

Adolescent↗

PubMed2002

Conventional and diffusion-weighted MR imaging of intracranial tuberculomas. A case report.

Intracranial tuberculoma is a rare form of central nervous system tuberculosis. We here report on conventional and diffusion-weighted cranial MR images of a non-immunocompromised patient with multiple intracranial tuberculomas, tuberculous lymphadenitis and pulmonary tuberculosis. Conventional MR imaging revealed multiple ring-enhancing mass lesions. At follow-up MR, appearances of both edema and number and size of nodules were decreased. Diffusion-weighted MR was normal and normal ADC values were found in this case of tuberculomas.

Adult↗

PubMed2003

Brain CT and MRI findings in 100 consecutive patients with intracranial tuberculoma.

OBJECTIVE: The characteristics of intracranial tuberculoma on computed tomography (CT) and magnetic resonance imaging (MRI) are not well known. The authors reviewed the features of tuberculoma on CT scans and MRI. The authors also correlated the MRI characteristics on various pulse sequences with neuropathological findings. METHODS: The charts of patients with intracranial tuberculoma were consecutively reviewed during the period from 1988 to 1999. The diagnosis of tuberculoma was based on pathology (n = 19), clinical or neuroimaging response to tuberculous chemotherapy (n = 57), or evidence of systemic tuberculosis (n = 24). Neuropathological specimens of tuberculoma were graded for the amount of fibrosis, gliosis, necrosis, and cell types (lymphocytes, macrophages, plasma cells). RESULTS: One hundred patients (43 men) were identified. The age range was 1 to 75 years (mean = 30 y). The number of lesions ranged from 1 to > 100 (mean = 4.5 lesions/patient). Thirty-one patients had solitary lesions, whereas 69 had multiple lesions. Thirty-seven patients had hydrocephalus. After contrast administration, > 450 lesions were seen on CT and MRI images in all 100 scans. The diameter of these enhancing lesions ranged from 1 mm to 5 cm. Lesions > 1 cm showed varied enhancement, including irregular shapes, ringlike shapes, open rings, and lobular patterns. Targetlike lesions were seen in only 2 patients. Other features included cortical and subcortical infarcts (12 patients), calcification (10% of lesions), edema (33 patients), meningeal enhancement (12 patients), mass effect, and/or midline shift (18 patients). A hypointense core with a hyperintense rim was the most common signal characteristic on T2-weighted MRI. The central hypointensity on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images reflected extensive necrosis and hypercellularity. CONCLUSION: Multiple tuberculomas and infratentorial locations were more common in the authors' patient population than in previous reports. The MRI signal characteristics of intracranial tuberculoma are extremely diverse. An isointense or hypointense core with a hyperintense rim on T2-weighted and FLAIR images is the most common presentation. Core hypointensity of lesions on these images is related to necrosis and the large number of cells.

Adolescent↗

PubMed1999

Diagnostic efficacy of stereotactic biopsies in intracranial tuberculomas.

BACKGROUND: Stereotactic biopsies for diagnosing intracranial tuberculomas are often reported to be inconclusive, being confirmatory in only 28% of cases. We analyzed the role and diagnostic efficacy of stereotactic biopsies in the management of intracranial tuberculomas. METHODS: Twenty patients diagnosed with intracranial tuberculomas based on neuroimaging procedures underwent computerized tomography (CT) guided stereotactic biopsies for histological confirmation. In 10 patients (Group A), biopsies were obtained from the center of the lesion; in the other 10 (Group B), biopsies were obtained from both the enhancing rim and the isodense center and examined separately. The tissues were processed for paraffin sections and hematoxylin eosin staining. In addition, in the first five patients a squash smear from a small portion of the biopsy was prepared, and the cytological features of the cells were examined. All the patients received antitubercular medication and CT scans were repeated 4 months posttreatment. RESULTS: Histopathological features of the paraffin sections in 17 patients (Group A: 8, Group B: 9) were diagnostic of tuberculoma, whereas the other three revealed only chronic nonspecific inflammation. Based on the cytological features in squash smears, diagnosis could be made in one of five. In two, although the smear was not diagnostic, the histological section from the same specimen confirmed the tuberculous pathology. There was no procedural morbidity or mortality. One patient had a small asymptomatic hematoma at the biopsy site. Three patients died during the follow-up period, due to secondary complications of tuberculosis. Repeat CT scans during follow-up after antituberculous treatment confirmed the reduction in the size of the lesion in 15/17 patients. CONCLUSION: The high positive yield of stereotactic biopsies in diagnosing tuberculomas argues for their inclusion in the management protocol for tuberculous mass lesions.

Biopsy↗

PubMedDate not supplied

Intracranial tuberculomas and caries spine: an experience from Children's Hospital Islamabad.

BACKGROUND: Pulmonary tuberculosis in infants and children in Pakistan is quite common. However, there is limited data about uncommon forms of tuberculous infection of central nervous system. Tuberculosis of nervous system is a serious disease and if not treated adequately, carries high morbidity and mortality. This study was undertaken to highlight the occurrence of relatively uncommon forms of tuberculosis in children. METHODS: This was a retrospective review of the case records of the patients who were admitted in Children's Hospital, Islamabad with the diagnosis of cerebral tubercloma or tuberculosis of spine between January, 1994 and August, 2002. Diagnosis was based on clinical features, history of contact with tuberculous patient, abnormalities on chest X-rays and neuroimaging studies of brain and spine. RESULTS: Nine children had cerebral tuberculomas, six more than one and in five were bilateral. Eight had caries spine, 2 cervical, 4 thoracic and 2 lumbar regions. Three had been vaccinated with Bacillus-Calemette-Guerin and family history of tuberculosis was positive in 7 (41%) children. Nine (53 %) patients had evidence of pulmonary tuberculosis on chest x-ray. Ten computed scan brain, four magnetic resonance imaging, two spinal scan and two myelographic studies were performed. Three patients with tuberculomas and five with caries recovered and 8 were left with neurological deficit. One child with cerebral tuberculomas died. CONCLUSION: Intracranial tuberculomas and spinal tuberculosis are not rare problems in children. Early diagnosis and prompt antituberculous therapy are the most important factors for the favourable outcome.

Age Distribution↗

PubMed1989

[The cause of paradoxical growth of intracranial tuberculomas during anti-tuberculous chemotherapy].

A case of multiple intracranial tuberculomas diagnosed by enhanced brain CT scan and MRI, which developed during the course of miliary tuberculosis under anti-tuberculous chemotherapy was experienced. Chemotherapy with an increased dose of each agent and corticosteroid was administered, and eventually intracranial tuberculomas nearly disappeared. After 1970, there have been 29 reported cases of intracranial tuberculomas in Japan, which were diagnosed by brain CT and treated with anti-tuberculous agents. Among them, 27 evaluable cases were classified into 3 groups. Group A: Intracranial tuberculomas were proved by CT before chemotherapy in 7 cases. Four of them enlarged during chemotherapy. Group B: During chemotherapy of tuberculous meningitis, neurological symptoms worsened or prolonged, and finally intracranial tuberculomas were found by CT in 9 cases. In 5 of them, after meningitis was improved by chemotherapy, neurological symptoms worsened and intracranial tuberculomas were found. Group C: During chemotherapy of pulmonary tuberculosis or miliary tuberculosis, neurological symptoms appeared and intracranial tuberculomas were found by CT in 11 cases (including our own case). Getting 3 groups together, intracranial tuberculomas seem to have worsened during chemotherapy in 24 out of 27 evaluable cases. In view of response to chemotherapy, these 24 cases can be divided into 2 categories: 1) non-responders to chemotherapy; 2) cases finally cured by chemotherapy ("transient worsening").(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

Paradoxical response of intracranial tuberculomas during chemotherapy: an immunologic phenomenon?

Intracranial tuberculomas are rare in developed countries, occurring mostly in non-Caucasian patients. We describe a white Dutch patient with miliary tuberculosis, who was noted to have intracranial tuberculomas on computed tomographic scanning. During antituberculous chemotherapy the systemic tuberculosis was responding satisfactorily, while intracranial tuberculomas developed or enlarged. Although this caused anxiety and led to some changes in chemotherapy, the lesions eventually disappeared. Possible mechanisms of this paradoxical response are discussed.

Antitubercular Agents↗

PubMedDate not supplied

Paradoxical intracranial tuberculoma requiring surgical treatment.

Paradoxical enlargement of intracranial tuberculomas or development of new ones during adequate antituberculous chemotherapy is an uncommon event. Treatment of such cases is controversial. Steroid therapy is usually advocated without change in the antituberculous drug program. However, in some patients whose lesions fail medical treatment, or who have superficially located large lesions, surgical therapy may be required. A 15-year-old girl with pulmonary miliary tuberculosis, tuberculous meningitis and multiple intracranial tuberculomas is presented. While her pulmonary lesions and intracranial tuberculomas except one were healed with chemotherapy, one tuberculoma increased in size 1 month after starting chemotherapy. She was followed with dexamethasone treatment in addition to antituberculous therapy for 2 months. Then, the lesion was removed because it had increased in size in spite of appropriate chemotherapy.

Adolescent↗

PubMed1996

[The diagnosis and treatment of intracranial tuberculoma].

OBJECTIVE: To improve the level of diagnosis and treatment of intracranial tuberculoma. METHODS: Fourteen intracranial tuberculoma cases were hospitalized in the past five years, accounting for 0.9 per cent of the intracranial tumors in the same period. Five out of fourteen cases were treated conservatively while other nine were treated surgically. All the cases were received 6-month short-course anti-tuberculosis chemotherapy, among which only one case's treatment was prolonged to one year. RESULT: All the cases had good outcome, none of them dead. CONCLUSIONS: Operative indications of intracranial tuberculoma cases should be applied strictly. Good result could be gained via a short-course anti-tuberculosis chemotherapy, no matter operation was performed or not.

Adolescent↗

PubMed1991

Diagnostic dilemma and therapeutic non-compliance in a case of intracranial tuberculoma.

A case of extensive intracranial tuberculoma is presented. The patient had been treated for 5 years with a standard antituberculosis regimen but she had been grossly non-compliant. This had led to emergence of multi-resistant Mycobacterium tuberculosis producing progressive disease and extensive cranial nerve damage and proptosis. The unusual CT and angiographic appearances cast doubt on the original diagnosis and a brain biopsy was necessary. Mycobacterium tuberculosis resistant to isoniazid, rifampicin, ethambutol, ethionamide, pyrazinamide, clofazimine and PAS was cultured from the brain biopsy specimen and from an associated groin abscess. A novel regimen of isoniazid, cycloserine, amikacin and ciprofloxacin produced clinical improvement of symptoms and radiological resolution.

Adult↗

PubMed1998

Intracranial tuberculoma in Kuwait.

OBJECTIVE: To study the manifestations of intracranial tuberculoma in Kuwait and to provide guidelines for the diagnosis and management of intracranial tuberculoma in developing countries, where the disease is common and facilities are limited. DESIGN: Data were collected from patients with intracranial space-occupying lesions admitted to Adan Hospital Medical Department and the Neurosurgery and Neuromedical Departments at Ibn-Sina Hospital, Kuwait, from January 1987 to December 1995. RESULTS: Intracranial tuberculomas represented 1.4% of all cases with intracranial space-occupying lesions in these hospitals (13/925); 77% of the patients were males, and seizures were the most frequent presenting symptom. Nine patients (66.6%) responded well to medical treatment and four (33.3%) failed to respond. Those who responded to medical treatment showed remarkable improvement of the intracranial lesions within 6 weeks, and almost complete resolution within 12 weeks. Seven patients required surgery, three due to failure of medical treatment. We report a patient who needed emergency shunt operation, a patient with pituitary tuberculoma, and two patients whose lesions recurred several years after surgery. CONCLUSION: Bearing in mind the non-specific nature of computed tomography and magnetic resonance imaging in the diagnosis of intracranial tuberculoma, and the lack of advanced neurosurgical facilities in developing countries where the disease is common, we recommend a 6-week therapeutic test for patients with solitary or multiple enhancing intracranial space-occupying lesions without mass effect. Stereotactic biopsy is recommended in selected cases wherever facilities are available.

Adolescent↗

PubMed1994

Predictive value of computed tomography-based diagnosis of intracranial tuberculomas.

The need to obtain histological diagnoses of intracranial tuberculomas, before initiating therapy, is not universally accepted, because some clinicians believe that an image-based diagnosis is fairly accurate in patients from endemic regions. To evaluate the sensitivity, specificity, and predictive value of computed tomography (CT)-based diagnosis of an intracranial tuberculoma, we prospectively compared the preoperative imaging diagnoses with histological diagnoses in 105 consecutive patients with intracranial masses. CT differential diagnoses (first or second) of tuberculomas were considered in 21 patients. Seven of them were histologically confirmed to have tuberculomas (true-positive results); 14 had other diseases (false-positive results). The 14 false-positive cases included 6 cases of astrocytomas, 5 of metastases, and 3 with miscellaneous diagnoses. All tuberculomas were correctly diagnosed on the CT scans (5 by both surgeons and 2 by one surgeon). During the study period, we encountered 11 patients who were referred by other clinicians with diagnoses of tuberculomas on the basis of their CT scans. We concurred with their CT diagnoses in 5 of them, but only 1 patient had a histologically verified tuberculoma. Astrocytomas (4 patients), metastases (3 patients), and solitary cysticercus granulomas (3 patients) were the causes of misdiagnosis in this group of patients. Although the sensitivity of CT in the diagnosis of intracranial tuberculomas is 100%, and its specificity is 85.7%, the positive predictive value is only 33% (confidence limits, 24-42%). The negative predictive value is 100%. The low positive predictive value for a diagnosis of intracranial tuberculoma on CT alone indicates the need for a confirming histological diagnosis.

Adolescent↗

PubMed1989

Intracranial tuberculoma: MR imaging.

MR studies of 6 patients with intracranial tuberculoma are reviewed. All patients also underwent CT scans which showed hypo- or isodense lesions with abnormal enhancement following contrast administration. MR showed lesions with prolongation of the T1 relaxation time in every case. On the T2-weighted sequences, the signal properties of the tuberculoma varied according to the stage of evolution of the lesion. Incipient tuberculomas appeared as scattered areas of hypointensity surrounded by edema. Mature tuberculomas were composed of a dark necrotic center surrounded by an isointense capsule which was, in turn, surrounded by edema. In one patient, the center of the lesion was hyperintense probably because of liquefaction and pus formation (tuberculous abscess). While both, CT and MR, were equally sensitive in visualizing the intracranial tuberculoma in every patient, MR was slightly superior in demonstrating the extent of the lesion, especially for brainstem tuberculomas. Nevertheless, the potential role for MR diagnosis of intracranial tuberculoma is limited by the fact that other infectious or neoplasic diseases may present similar findings. The diagnosis of intracranial tuberculoma should rest on a proper integration of data from clinical manifestations, cerebrospinal fluid analysis, and neuroimaging studies.

Adolescent↗

PubMed1994

Paradoxical enlargement or development of intracranial tuberculomas during therapy: case report and review.

Intracranial tuberculomas can sometimes develop or increase in size despite administration of appropriate therapy. We report the case of a child whose intracranial tuberculomas paradoxically enlarged while therapy was being administered, and we review 23 other cases in which tuberculomas increased in size or number and 17 cases in which tuberculomas appeared during therapy. These phenomena generally occurred within 3 months of the start of therapy. All but four patients had neurological deterioration that prompted obtaining a repeated computed tomographic scan. One patient died, about one-fourth of patients had residual neurological symptoms, and less than one-third of the patients required surgical intervention. Most patients received a 12-18 month course of antituberculous therapy. Adjunctive therapy with steroids appears to diminish neurological symptoms and may improve outcome. Paradoxical enlargement or development of tuberculomas usually does not represent failure of antituberculous therapy; the most likely explanation for these phenomena is an interaction between the host's immune response and the direct effects of mycobacterial products.

Antitubercular Agents↗

PubMed2005

Intracranial tuberculoma -- a diagnostic dilemma.

The characteristics of intracranial tuberculoma on computed tomography (CT) and magnetic resonance imaging (MRI) are not well known. The authors present a patient with an intracranial tuberculoma in whom the diagnosis was confirmed only after surgical excision.

Adolescent↗