Meningeal tuberculoma mimicking a brain tumor

Abstract

Meningeal tuberculoma is one of the most serious sites of tuberculosis. Its incidence varies depending on the geographical area, rare in Western countries and frequent in developing countries where it represents 5% to 10% of intracranial masses. We report the case of a 21-year-old male patient with no particular medical history from Africa and living in Europe for more than a year, is hospitalized for an isolated inaugural, generalized, afebrile seizure in whom the scanner and cerebral magnetic resonance imaging (MRI) revealed a meningeal mass with significant glove finger edema suggesting a primary brain tumor. Surgical excision and anatomopathological analysis of the excisional piece allowed the diagnosis of tuberculoma. Meningeal tuberculoma is a source of diagnostic error because its clinical and radiological expression can mimic a brain tumor. This is an etiology that should not be ignored in the face of a meningeal mass in any subject coming from or living in a region with a high endemic tuberculosis.

Keywords: Brain tumor; MRI; Meningeal tuberculoma; Scanner.

Fig. 1

Brain scan in axial section without injection of iodine contrast (A) and with injection (B) revealed an extra-axial right parietal tissue mass (star) taking contrast in a heterogeneous manner at the late stage with glove finger edema (arrow) without bone reaction facing it.

Fig. 2

Brain MRI. (A) Sagittal T1 slice: isosignal mass (star) surrounded by a hypointense edematous area. (B, T2 FLAIR axial slice): isointense mass (star) in the cortex surrounded by a hyperintense edematous area. (C, axial, coronal and sagittal T1 slices after injection of gadolinium).; meningeal mass of polylobulated outlines, intensely contrasting in heterogeneous ways (star) with nonenhanced areas in its anterior part (arrow head) with corticosubcortical edema (arrow) in a thimble pushing back the posterior horn of the right ventricular junction. (D) Spectrometry showed a peak in creatine choline with the presence of free lipid; without breakdown of other metabolites such as N-acetylaspartate and myoinositol.

Fig. 3

Thoracoabdominopelvic CT scan showing multiple coeliomesenteric abdominal lymphadenopathy (arrow).

Fig. 4

Postoperative control brain MRI. (A) axial flair slice showing a reduction in edema on D5 postoperative (arrow). (B) T1 axial slice after injection of gadolinium showed the excisional encephalic pore cavity facing the postoperative flap (arrow head).