Intracranial tuberculoma and recent advances in magnetic resonance imaging

Abstract

Background: Tuberculosis is resurging both in the developing and developed worlds. This includes TB of the central nervous system which is more common in children. It carries a high mortality rate and can lead to significant levels of neurological morbidity. Magnetic resonance imaging offers the potential to diagnose intracranial tuberculoma and to differentiate it from other single hyper dense intracranial lesions. Methods: The authors report thirteen patients who proved to have intracranial tuberculoma with emphasis on their magnetic resonance imaging. They all presented with varying degrees of raised intracranial pressure. All the thirteen patients had a CT scan which showed a single hyper dense lesion. After contrast the density of the lesions increased. To confirm the diagnosis of intracranial tuberculomas and to differentiate it from intracranial single hyper dense lesions, conventional pre and post contrast MRI imagining followed by FLAIR sequences and diffusionweighted echo-planner imagining (EPI) was carried out. Results: All our patients were treated by corticosteroids for eight weeks and anti-tuberculous medication for a minimum period of twelve months. The treatment was successful in all our patients and none required surgery. Conclusions: Early and clear diagnosis of intracranial tuberculoma can be achieved by MRI imaging including flair sequences and diffusion-weighted Echo-planner imaging, (EPI). This leads to early treatment and better outcomes of tuberculosis of the central nervous system. Trial registration: This study was not registered as a trial because it is a retrospective study that does not include any involvement in the management or follow-up of patients and as such did not require registering.

Presentation, diagnosis, and treatment of a cerebellar tuberculoma: illustrative case

“…Treatment options for intracranial tuberculomas remain limited and consist primarily of a four-medication anti-TB regimen of isoniazid, rifampin, ethambutol, and pyrazinamide (RIPE) with or without corticosteroids to treat the associated cerebral edema. 9,10 Here we present a case showing efficacy of the adjunct use of resection of a solitary cerebellar tuberculoma without active or latent TB infection, leading to the cessation of symptoms and removal of the primary lesion. Resection of these lesions has been previously reported, 2,8,15 particularly in lesions causing significant CNS symptoms and obstructive hydrocephalus or strongly mimicking other pathologies.…”

“…These discrete tuberculoma lesions can present in unique manners, masquerading as hematomas, 2 intracranial tumors, 3,4 or multiple CNS lesions, 5 and they are commonly found in children, immunosuppressed patients, or patients with active TB. [6][7][8] On computed tomography (CT) and magnetic resonance imaging (MRI), tuberculomas typically appear as ring-enhancing or hyperdense lesions with associated edema, 9,10 although distinctive imaging characteristics are not well established. Because of this, intracranial tuberculomas can be misdiagnosed as numerous other intracranial pathologies, particularly when there is a low suspicion of active TB or prior exposure.…”

Intracranial space-occupying lesion masked by alcohol dependence syndrome

“…Clinical presentations are seizure, headache, hemiplegia, and signs of raised intracranial pressure. [ 6 ] In general, adults have frontal or parietal lobe involvement, and children have infratentorial involvement.…”

MR textural features (RADIOMICS) for predicting response to treatment in patients with intracranial tuberculoma: A retrospective cross-sectional study

“…These lesions are known to have various signals on conventional MRI imaging depending upon its stage of evolution. 2,3 MRI spectroscopy has proven to be a useful modality at differentiating these lesions from other intracranial pathologies including infections and malignancy. 4 Published literature describes the effectiveness of CT perfusion markers in differentiating treated and untreated tuberculomas, however to the best of our knowledge no clinical and imaging method exists which can predict the response to treatment in a brain tuberculoma at initial presentation.…”