Brain tuberculoma, an unusual cause of stroke in a child with trisomy 21: a case report

Abstract

BackgroundTuberculosis remains a public health problem in developing countries and is associated with lethal central nervous system complications. Intracranial tuberculomas occur in 13% of children with neurotuberculosis. Patients with trisomy 21 have an increased risk for stroke, which usually stems from cardiovascular defects.Case presentationWe report a case of a 12-year-old Sudanese boy with trisomy 21 who was presented to our hospital with focal convulsions and right-sided weakness. The results of neuroimaging and histopathological examinations were consistent with cerebral tuberculoma. The patient had a good initial response to antituberculosis drugs and steroids. To the best of our knowledge, this is the first case report of multiple brain tuberculomas described in a child with trisomy 21.ConclusionsPatients with trisomy 21 have an increased risk for stroke. Our patient had an exceptional case of stroke caused by tuberculoma. The present case emphasizes the need to consider tuberculomas in the differential diagnosis of children with neurological symptoms living in areas of high tuberculosis incidence.

Intracerebral tuberculomas: A rare cause of seizure in an immunocompetent young male

“…These foci can enlarge and exert local mass effects without necessarily rupturing into the subarachnoid space [1,4,[6], [7], [8], [9], [10]]. The symptoms of tuberculomas are nonspecific, which may include headache, seizures, cranial nerve palsies, or other clinical signs of increased intracranial pressure [1,3,4,6,7,[9], [10], [11]]. Such symptoms are essentially indistinguishable from any other space occupying lesion, making it necessary to evaluate for alternative noninfectious and infectious etiologies such as malignancy, sarcoidosis, pyogenic abscess, toxoplasmosis, bartonellosis, or syphilis.…”

“…Although the definitive diagnosis of intracerebral tuberculomas technically involves intracranial biopsy and histopathology, this approach is often impractical due to its invasive nature, close proximity of lesions to life-critical structures, and the risk of meningitis from accidental seeding of the subarachnoid space [4,5]. This very challenge underscores the importance of detecting adjunctive, extracranial evidence of active TB supporting the diagnosis of intracranial tuberculomas [[3], [4], [5], [6], [7], [8]].…”

Aggressive intracerebral tuberculoma in a 1-year-old child: A case report with literature review

“…The prevalence of Central nervous system tuberculoma is a rare entity that accounts about 1% of all tuberculosis (TB) and remains a serious global public health problem in world especially in the developing countries. It is a severe form of Intracranial granulomatous caused by the hematogenous spread of Mycobacterium tuberculosis infection from the primary site to the brain parenchyma, ventricle, and meninges [1 , 2] , and carries significant mortality and morbidity [3] . Cerebral TB can arise anywhere in the brain, but usually areas with abundant blood supply.…”

Seizures in a child with tuberculomas: case report

“…Central tuberculomas are a rare and serious form of TB due to haematogenous spread of Mycobacterium Tuberculosis. Symptoms are radiologic features are non specific, leading sometimes to misdiagnosis 1 Intracranial tuberculomas occur in 13% of children with neurotuberculosis 2 It can present as altered mental status, stiff neck, decreased level of consciousness, increased intracranial pressure, and cranial nerve involvement 3 The main challenge in the management of brain tuberculoma is its diagnosis. CSF examination is often normal and biopsy and tissue culture are not feasible most of the time.…”