A giant fourth-ventricular tuberculoma mimicking a primary posterior fossa tumor

Abstract

Typically, an intracranial tuberculoma occurs within the brain parenchyma. Intraventricular tuberculomas are rare in the absence of systemic tuberculosis (TB), and the differential diagnosis between tuberculoma and other lesions, such as primary brain tumors, can be difficult. We report an extremely unusual case of solitary fourth-ventricular tuberculoma, which occurred in a 3-year-old female patient, with no indication of TB. This lesion appeared as a primary intraventricular tumor in the fourth ventricle in both clinical and radiological examinations. In this scenario, a surgical treatment option was pursued. Histopathological testing supported the diagnosis of tuberculoma. The patient was subsequently treated with 18 months' therapy for tuberculous, without adverse events.

Keywords: fourth ventricle; infratentorial neoplasms; intracranial; tuberculoma; tuberculosis.

Figure 1

Axial T2-weighted image shows a predominantly cystic mass located in the fourth ventricle.

Figure 2

Axial susceptibility-weighted image shows no calcification or hemosiderin inside the mass.

Figure 3

Axial T1-weighted image with contrast agent reveals a giant ring-enhancing mass.

Figure 4

Axial diffusion-weighted image (left panel) and apparent diffusion coefficient (ADC) map (right panel) of the intraventricular lesion (region of interest (ROI) central) and normal-appearing parenchyma (ROI left).

Figure 5

Axial T1-perfusion image (upper left) and perfusion map (upper right) of the lesion (tumor) and normal-appearing parenchyma (reference). T1-perfusion parameters (lower left); and time–signal intensity curves for the tumor (blue) and the parenchyma (orange) (lower right).