Tuberculoma of the brain--report of 2 cases and review of literature

Abstract

Tuberculomas of the brain are relatively uncommon in developed countries nowadays. We report the only two cases that were seen in our Department in the last five years. Both patients presented with seizures and were found to have space occupying lesions on cranial CT scanning. They had no past history of tuberculosis, no evidence of current extracranial tuberculosis and the diagnosis of tuberculoma was made at the time of surgical excision. Underdiagnosis of tuberculoma of the brain is likely to occur in industrialised countries where tuberculosis is rare. The radiological investigation of choice is CT scanning with contrast enhancement and the presence of a target lesion is considered to be pathognomonic of a tuberculoma. Most tuberculomas of the brain can be treated medically with antituberculous chemotherapy. We recommended obtaining a definitive histological diagnosis with CT-guided stereotactic techniques prior to commencing antituberculous therapy. Surgical excision is necessary in patients with raised intracranial pressure secondary to the lesion and not responding to medical therapy.