Disseminated Intracranial Tuberculoma Mimicking Neurocysticercosis

Abstract

Intracranial tuberculoma and neurocysticercosis (NCC) are the most frequent granulomatous infections in the central nervous system. Here we report a 41-year-old man with disseminated intracranial tuberculoma mimicking NCC. The patient complained of relapsing vertigo and vomiting consistent with Bruns syndrome. Serum antibodies against cysticercosis were positive. Magnetic resonance imaging (MRI) of the brain showed multiple disseminated ring-enhanced lesions. An initial diagnosis of NCC was made based on clinical signs and MRI. However, during antiparasitic treatment, the patient exhibited fever, meningitis signs, and positive cerebrospinal fluid findings for tuberculosis. The diagnosis was therefore corrected as tuberculoma. After three months of antituberculous treatment, the patient recovered clinically and on MRI. Our results highlight the importance of differential diagnosis of these two diseases in the early stage.

Monocyte Gene Expression Distinguishes Enhancing Brain Parenchymal Cysticercal Granulomas From Tuberculomas

“…Based on these criteria, lesion size >20 mm excludes the diagnosis of cysticercal granuloma. However, the presence of multiple lesions, all <20 mm in size, can make it difficult to distinguish between pNCC and tuberculoma, as well as from other pathologies such as metastasis or pyogenic/fungal abscesses [ 12 , 21–23 ]. Multiple pNCC is diagnosed with near certainty on MRI when scolices are identified in any of the lesions or when there are lesions displaying different stages of the cysticercus, that is, live cysts, granulomas, and calcifications.…”

“…Multiple pNCC is diagnosed with near certainty on MRI when scolices are identified in any of the lesions or when there are lesions displaying different stages of the cysticercus, that is, live cysts, granulomas, and calcifications. But it is difficult to make a diagnosis with certainty when only enhancing parenchymal lesions are seen [ 6 , 12 , 21–23 ]. In a series of 110 Indian patients with multiple brain lesions, tuberculosis and cysticercosis were the most common diagnoses [ 6 ].…”

“…When a clear distinction between pNCC and tuberculoma cannot be made on imaging, brain biopsy is often the only option available to establish diagnosis. However, in most clinical settings, clinicians resort to empiric treatment with a therapeutic trial of albendazole or antituberculous therapy, and may change from 1 treatment to the other when there is no clinical or radiological response [ 12 ].…”

Intraventricular neurocysticercosis presenting as Bruns’ syndrome: An uncommon presentation

“…Mechanism of hydrocephalus is either ventricular obstruction or arachnoiditis (either basal or spinal). Bruns' syndrome has been originally described in fourth ventricular NCC but has also been reported in other lesions like third ventricular lesions [4,5]. Lu Zhengqi and colleagues described the first case of Bruns' syndrome secondary to tuberculoma which mimicked neurocysticercosis and the patient improved on treatment.…”

Disseminated cysticercosis in an immunocompetent individual

“…In developing countries, where both the diseases are endemic, tuberculoma remains the single most important differential diagnosis. [67] The differentiation can be achieved with the help of MR spectroscopy.…”