Isolated thalamic tuberculoma presenting as ataxic hemiparesis

Abstract

SUMMARYLacunar syndrome is a neurodeficit secondary to a deep cerebral lesion, usually because of microatheroma of small arteries. Ataxic hemiparesis (AH) is a lacunar syndrome with unilateral pyramidal weakness and ipsilateral ataxia. Thalamic tuberculoma, as a cause of AH, has not been previously described in the literature. We describe an elderly man who presented with left hemiparesis and ipsilateral ataxia. Clinical examination revealed upper motor neuron left facial paresis and leftsided hemiparesis. The patient had incoordination in left upper and lower limbs. Mantoux test was positive and erythrocyte sedimentation rate was elevated. MRI of brain showed a conglomerated hypointense lesion in the right thalamus with a peripheral hyperintensity on T1-weighted imaging and a hyperintense lesion in T2-weighted imaging with significant perilesional oedema, suggesting a tuberculoma. The patient was treated with antitubercular therapy and was symptomatically better at the 9 months follow-up. BACKGROUND

Focal dystonia and ataxic hemiparesis as the initial presentation of a thalamic tuberculoma: A diagnostic challenge in an immunocompetent pediatric patient

“…Sahu et al [10] have the first to describe ataxic hemiparesis of a lacunar syndrome secondary to a thalamic tuberculoma in a 65-year-old immunocompetent patient whose chief complaint was similar to our case. [10] e presenting gait in such cases is most likely the result of a distortion to the dentatorubrothalamic tract carrying fibers from the contralateral cerebellum to the ventrolateral nucleus. [10] e associated hemiparesis may likely be from perilesional edema compressing the internal capsule, and the lack of sensory symptoms could result from the spared ventral posteromedial/lateral nuclei.…”

“…[5] In the absence of such a sequela, a pediatric immunocompetent vaccinated patient, the "thalamic hand (indicating dystonia) presenting" with ataxic hemiparesis is indeed a rarity, and acute development of such a presentation would more likely point toward an event of ischemic/infarct. [1,3,10] However, as in our case, the gradual development of these symptoms is more in line with a space-occupying lesion such as pediatric tumors, which are far more common. Sahu et al [10] have the first to describe ataxic hemiparesis of a lacunar syndrome secondary to a thalamic tuberculoma in a 65-year-old immunocompetent patient whose chief complaint was similar to our case.…”

“…[1,3,10] However, as in our case, the gradual development of these symptoms is more in line with a space-occupying lesion such as pediatric tumors, which are far more common. Sahu et al [10] have the first to describe ataxic hemiparesis of a lacunar syndrome secondary to a thalamic tuberculoma in a 65-year-old immunocompetent patient whose chief complaint was similar to our case. [10] e presenting gait in such cases is most likely the result of a distortion to the dentatorubrothalamic tract carrying fibers from the contralateral cerebellum to the ventrolateral nucleus.…”

“…[ 10 ] The presenting gait in such cases is most likely the result of a distortion to the dentatorubrothalamic tract carrying fibers from the contralateral cerebellum to the ventrolateral nucleus. [ 10 ] The associated hemiparesis may likely be from perilesional edema compressing the internal capsule, and the lack of sensory symptoms could result from the spared ventral posteromedial/lateral nuclei. [ 10 ] We could find only three cases where an ataxic hemiparesis presentation was due to an intracranial tuberculoma in immunocompetent patients, with our case being the first in a child.…”

Case Study on Young Stroke Right Ataxic Hemiparesis with Type 1 Diabetes Mellitus

“…Day 5-8, She had shown improvement in her conditions. On undergoing physiotherapy classes, she is now able to stroll, and she was advised to follow the medication regimen regularly [5,6].…”