Diagnosis and neurosurgical treatment of tuberculous disease of the CNS

Abstract

The tuberculoma is a space-occupying lesion encountered frequently by all Indian Neurosurgeons. Some features indicate the possibility of such a lesion. These are: tuberculous disease in the past or contact with a tuberculous patient, a positive Mantoux test, pyrexial onset of the disease and frequent history of seizures. The radiological features are not diagnostic, but the presence of multiple, enhancing lesions on the CT scan in a young patient, strongly suggest tuberculomas. Surgical excision of the lesion is recommended, partial near vital areas, and sometimes, with tuberculomas in areas like the thalamus and brain stem only medical therapy is advisable. Long-term medical treatment is necessary. Towards eradication of the disease all those close to the patient need to be examined for early detection of asymptomatic tuberculosis.