RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0040-1708895
Brain Tuberculoma as a Differential Diagnosis of Single Intracranial Lesion: Case Report
Tuberculoma cerebral como diagnóstico diferencial de lesão intracraniana única: Relato de casoPublikationsverlauf
14. August 2019
15. Januar 2020
Publikationsdatum:
06. April 2020 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00028832/202002/lookinside/thumbnails/10-1055-s-0040-1708895_1900056-1.jpg)
Abstract
Tuberculosis (TB) of the central nervous system (CNS) is considered one of the most severe forms of presentation of the disease. Although only 1% of TB cases involve the CNS, these cases represent around between 5 and 15% of extrapulmonary forms.[1] [2] Tuberculous meningitis (TBM) is the most frequent form of CNS TB. The granulomas formed in the cerebral tuberculoma may cause hydrocephalus and other symptoms indicative of a CNS mass lesion. In the absence of active TB or TBM, the symptoms may be interpreted as indicative of tumors.[3] [4] The prognosis is directly related to the early diagnosis and proper treatment installation.[5] We report the case of a patient with intracranial hypertension syndrome, expansive mass in the parieto-occipital region, accompanied by a lesion in the rib, initially thought to be a metastatic lesion, although posteriorly diagnosed as a cerebral tuberculoma.
Resumo
A tuberculose (TB) do sistema nervoso central (SNC) é considerada uma das formas mais graves de apresentação da doença. Embora apenas 1% dos casos de TB envolvam o SNC, isto representa aproximadamente entre 5 e 15% das formas extrapulmonares.[1] [2] A meningite tuberculosa é a forma mais frequente de TB do SNC. Os granulomas formados no tuberculoma cerebral podem causar hidrocefalia e outros sintomas indicativos de lesão com efeito de massa no SNC. Na ausência de TB ativa ou meningite tuberculosa, os sintomas podem ser interpretados como indicativos de tumores intracranianos.[3] [4] O prognóstico está diretamente relacionado ao diagnóstico precoce e instalação adequada do tratamento.[5] Relatamos o caso de um paciente com síndrome de hipertensão intracraniana, formação expansiva em região parieto-occipital esquerda, acompanhada por lesão em arco costal, inicialmente tida como metástase, com posterior diagnóstico de tuberculoma cerebral.
-
References
- 1 Anderson JM, Macmillan JJ. Intracranial tuberculoma--an increasing problem in Britain. J Neurol Neurosurg Psychiatry 1975; 38 (02) 194-201
- 2 Dastur HM, Desai AD. A comparative study of brain tuberculomas and gliomas based upon 107 case records of each. Brain 1965; 88 (02) 375-396
- 3 Mathai KV, Chandy J. Tuberculous infections of the nervous system. Clin Neurosurg 1966; 14: 145-177
- 4 Dastur DK, Manghani DK, Udani PM. Pathology and pathogenetic mechanisms in neurotuberculosis. Radiol Clin North Am 1995; 33 (04) 733-752
- 5 D'Giano CH, Fernández Boan O, Rey RC, Scornik J, Figini HA, Garcea DO. [7 cases of intracranial tuberculoma]. Medicina (B Aires) 1985; 45 (06) 649-653
- 6 Leonard JM. Central Nervous System Tuberculosis. Microbiol Spectr 2017; 5 (02) 17-44
- 7 Traub M, Colchester AC, Kingsley DP, Swash M. Tuberculosis of the central nervous system. Q J Med 1984; 53 (209) 81-100
- 8 Bagga A, Kalra V, Ghai OP. Intracranial tuberculoma. Evaluation and treatment. Clin Pediatr (Phila) 1988; 27 (10) 487-490
- 9 Harder E, Al-Kawi MZ, Carney P. Intracranial tuberculoma: conservative management. Am J Med 1983; 74 (04) 570-576
- 10 DeLance AR, Safaee M, Oh MC. , et al. Tuberculoma of the central nervous system. J Clin Neurosci 2013; 20 (10) 1333-1341
- 11 Ildan F, Gürsoy F, Gül B, Boyar B, Kihiç C. Intracranial tuberculous abscess mimicking malignant glioma. Neurosurg Rev 1994; 17 (04) 317-320
- 12 Capone D. , et al. Extrapulmonar Tuberculose. Rev Hosp Univ Pedro Ernesto 2006; 5 (02) 54-67
- 13 Barroso EC. , et al. Tuberculoma cerebral. J Bras Pneumol 2002; 28 (85) 55-58
- 14 World Health Organization. Global tuberculosis control. In: World Health Organization report 2011. Geneva: World Health Organization; 2011: 1-258
- 15 Monteiro R, Carneiro JC, Costa C, Duarte R. Cerebral tuberculomas - A clinical challenge. Respir Med Case Rep 2013; 9 (01) 34-37
- 16 Sahaiu-Srivastava S, Jones B. Brainstem tuberculoma in the immunocompetent: case report and literature review. Clin Neurol Neurosurg 2008; 110 (03) 302-304
- 17 Hejazi N, Hassler W. Multiple intracranial tuberculomas with atypical response to tuberculostatic chemotherapy: literature review and a case report. Acta Neurochir (Wien) 1997; 139 (03) 194-202
- 18 Costa FAO, Silva SHF, Fabião Neto OM, Jorge VM, Silva MMG, Balzano PC. Tuberculoma cerebral simulando neoplasia. Arquivos Brasileiros de Neurocirurgia 1995 14.
- 19 Rock RB, Olin M, Baker CA, Molitor TW, Peterson PK. Central nervous system tuberculosis: pathogenesis and clinical aspects. Clin Microbiol Rev 2008; 21 (02) 243-261
- 20 Ogbole GI, Bassey OS, Okolo CA, Ukperi SO, Ogunseyinde AO. Testicular tuberculosis presenting with metastatic intracranial tuberculomas only: a case report. J Med Case Reports 2011; 5: 100
- 21 Weisberg LA. Granulomatous diseases of the CNS as demonstrated by computerized tomography. Comput Radiol 1984; 8 (05) 309-317
- 22 Whelan MA, Stern J. Intracranial tuberculoma. Radiology 1981; 138 (01) 75-81
- 23 Alamé T, Keller K, Michel O, Sergysels R. Hyperthermia occurring with paradoxical development of cerebral tuberculomas. Respiration 1996; 63 (06) 381-383
- 24 Carbajal JR, Torres LM, Tosi PL. , et al. Tuberculoma cerebral: estudio clínico y radiográfico de 31 casos. Gac Med Mex 1986; 122: 205-211
- 25 Dao DA, Lee PW, Roy TM. Intracranial tuberculoma. J Ky Med Assoc 1990; 88 (03) 121-124
- 26 Castaêda C, Rivera H, Hinostroza E. Tuberculoma cerebral: correlato clínico-tomográfico y evaluación del tratamiento. Rev Med Inst Peru Segur Soc 1994; 3: 7-13
- 27 Bouchama A, al-Kawi MZ, Kanaan I. , et al. Brain biopsy in tuberculoma: the risks and benefits. Neurosurgery 1991; 28 (03) 405-409
- 28 Martínez-Vázquez C, Bordón J, Rodríguez-González A. , et al. Cerebral tuberculoma--a comparative study in patients with and without HIV infection. Infection 1995; 23 (03) 149-153
- 29 Bargalló J, Berenguer J, García-Barrionuevo J. , et al. The “target sign”: is it a specific sign of CNS tuberculoma?. Neuroradiology 1996; 38 (06) 547-550