Diagnostic challenges in cerebral tuberculoma presenting with seizures in pregnancy

Abstract

Tuberculoma is an uncommon presentation of tuberculosis and is found in regions with a high prevalence of tuberculosis. This is rarely diagnosed during pregnancy. The presentation can mimic other etiologies such as eclampsia or cerebral venous sinus thrombosis so the diagnosis can be challenging, particularly when presenting with seizures in pregnancy. Described here is a woman in her first pregnancy who presented with seizures mimicking eclampsia and was suspected to have a brain tumour on neuroimaging. She was diagnosed to have a intracerebral tuberculoma on histopathological examination following surgical decompression after delivery.

Keywords: pregnancy; seizures; tuberculoma; tumour.

Figure 1.

A- Plain axial CT scan of the brain at supraventricular level shows focal vasogenic edema involving left frontoparietal lobes, B- plain axial CT image at the level of the frontal horn of lateral ventricles shows midline shift to the right side by 11 mm, C- contrast-enhanced CT at supraventricular level shows evidence of enhancement along the sulci with thickening of the adjacent cortex, involving left frontoparietal lobes. No evident intra-parenchymal enhancing focal lesion, D- non-contrast CT post decompression craniotomy shows resolution of midline shift.

Figure 2.

Microphotograph showing normal brain parenchyma (right side- black arrow) with coalescing granulomatous lesion composed of aggregates of epitheloid cells, Langhans-type giant cells and lymphocytes. X 200 H&E.