Clinical Presentation Of CNS Tuberculoma

 The clinical presentation of CNS tuberculoma is usually more subtle than that of TB meningitis and may include headache, seizures, focal neurologic deficits, and papilledema. Tuberculomas accompany TB meningitis in 10% of patients and are multiple in a third of patients. Lesions may occur in the brain, spinal cord, subarachnoid, subdural, or epidural space; they may be solitary but are most often multiple and accompanied by surrounding edema and ring enhancement. In children, lesions tend to be infratentorial, whereas in adults they are typically supratentorial. On CT, tuberculomas are characterised as low- or high-density and rounded or lobulated masses and show intense homogenous or ring enhancement after contrast administration. They have an irregular wall of varying thickness. Moderate to marked perilesionaloedema is frequently present. Tuberculomas may be single or multiple and are more common in frontal and parietal lobes, usually in parasagittal areas. On CT, the target signâ, a central calcification or nidus surrounded by a ring that enhances after contrast administration, is considered pathognomonic of tuberculoma. Intracranial tuberculoma is one of the rare central nervous system manifestations of Mycobacterium tuberculosis (MTB), seen in only 1% of tuberculosis patients. It can manifest as single or multiple lesions, most commonly located in the frontal and parietal lobes. Clinical features are similar to any space-occupying lesion in the brain and can present in the absence of MTB symptoms in other parts of the body. In this article, a 69-year-old immunocompetent man, with history of treated latent tuberculosis infection (LTBI) was reported. He presented with multiple joint arthralgias, weight loss, odd behavior, forgetfulness, intermittent fevers and syncope. Brain imaging revealed numerous enhancing intra-parenchymal lesions in cerebral and cerebellar hemispheres. Patient was successfully treated with anti-tuberculosis medications and corticosteroids, with clinical improvement on future follow ups. High clinical suspicion for tuberculoma as a differential diagnosis of any brain lesion, even in immunocompetent patients in low MTB prevalence countries, can result in early diagnosis and successful clinical outcomes.