Late clinical manifestation of cerebral tuberculomas in two children with tuberculous meningoencephalitis

Rolinck-Werninghaus, Claudia; Kötz, Karsten; Magdorf, K.; Bunikowski, Rita; Staab, Doris; Wahn, Ulrich

doi:10.1007/s004310100795

Cited by 7 publications

(7 citation statements)

References 9 publications

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“…Tuberculoma formation has repeatedly been observed to coincide with tapering steroid doses (as in cases 9, 10, 11 and 17), indicating that the clinical situation might be dominated by a delayed type hypersensitivity response (Afghani and Liebermann, 1994). In contrast, the delayed occurrence of symptomatic tuberculomas in successfully treated TBM patients (as in cases 13, 18, 19 and 20) might support another hypothesis; a reaction to a local reactivation of non‐sterile granulomatous lesions (Rolinck‐Werninghaus et al. , 2001).…”

Section: Discussionmentioning

confidence: 93%

Clinical and radiological features of symptomatic central nervous system tuberculomas

Ünal

Sutlas

2005

Euro J of Neurology

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Tuberculomas may present with meningitis, may lead to meningitis, or may develop during the treatment of TBM. In this study, we report a series of 22 adult cases of symptomatic central nervous system tuberculomas, in eight of them tuberculomas were coexisting with TBM on admission and in 14 of them symptomatic tuberculomas developed during anti-tuberculosis therapy. We also aimed to compare the clinical, laboratory and outcome data of the 14 TBM patients that developed symptomatic tuberculomas, with the data of 41 TBM that did not, under the same treatment regimen. Most of the patients developed symptomatic tuberculomas in the first 6 weeks of treatment. Five patients developed late tuberculomas. The characteristics of tuberculomas and the role of corticosteroids in TBM patients are discussed. In conclusion, although steroids may diminish neurologic symptoms and improve outcome, tuberculomas may appear during the course of anti-tuberculosis and steroid treatment. Because of the possibility of late development of tuberculomas after initial successful treatment, all TBM patients need to be followed-up carefully for a long period.

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Section: Discussionmentioning

confidence: 93%

Clinical and radiological features of symptomatic central nervous system tuberculomas

Ünal

Sutlas

2005

Euro J of Neurology

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“…24,25 The case described by Martins et al 12 showed a much more favorable outcome than ours: in our case, the duration of the initial status epilepticus, the occurrence of an ischemic stroke, and the existence of multiple tuberculomas were clearly negative outcome factors. 22 Paradoxical enlargement of intracranial tuberculomas during adequate antituberculous chemotherapy has been reported previously, 8,10,14,16,[26][27][28] but the appearance of new extracranial lesions is more uncommon. This finding does not suggest that the ongoing treatment is inefficient, but usually justifies prolonged antituberculous chemotherapy.…”

Section: Discussionmentioning

confidence: 92%

Multiple Intracranial Tuberculomas Associated With Partial Status Epilepticus and Refractory Infantile Spasms

et al. 2008

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We report the case of a 10 month-old girl presenting with multiple intracranial tuberculomas associated with partial status epilepticus and cerebrovascular accident in the left sylvian territory. She later developed paradoxical enlargement of the tuberculomas during antituberculous treatment and severe neurological sequelae with refractory infantile spasms. The development of infantile spasms in this context is particularly remarkable, and this case is illustrative of the complex interrelationship between intracranial lesions, partial status epilepticus, and infantile spasms. It also highlights the difficult diagnosis of cerebral tuberculomas in infants and further supports the need for continued vigilance in industrialized countries.

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“…21 It is out of the scope of the current article to enumerate all agents of postinfectious acute cerebellar ataxia, but consideration in diagnosis may be lent to measles, mumps, herpes simplex virus, coxsackie A and B, hepatitis A, influenza A and B, parvovirus B19, echoviruses, poliovirus, Mycoplasma pneumoniae, and Legionella pneumophilia. [18][19][20][21]24 Additional etiologies that may present with acute cerebellopathies include tick paralysis, 25 cerebellar tuberculomas, 26 and brain stem encephalitis caused by Epstein-Barr virus, Listeria monocytogenes, or enterovirus 71 infection. 19 Acute disseminated encephalomyelitis is another autoimmune phenomenon typically preceded by infection that affects the entire brain and not only the cerebellum.…”

Section: Celiac Disease Cerebellar Ataxia and Pediatricsmentioning

confidence: 99%

Case Report of Subacute Cerebellar Ataxia of Adolescence With Long-Term Sequelae

2012

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Acute ataxia is not an uncommon childhood complaint. It most commonly occurs in young patients secondary to a postinfectious cerebellitis, which is typically associated with a very good prognosis and recovery. In adolescence, acute cerebellar ataxia is more often the product of an etiology likely to progress into a chronic disorder without recovery to preillness baseline. In the present case, the authors describe a 15-year-old girl with subacute cerebellar ataxia of presumed immune-mediated etiology that advanced into a chronic cerebellar ataxia. Due to a family history, celiac disease was suspected as the origin of the ataxia; biopsy ruled out enteropathy, and the severe, abrupt radiological changes to the patient's cerebellum are inconsistent with the reported sequelae of gluten ataxia. This case serves as a discussion for diagnostic challenges in adolescent patients with acute cerebellar ataxia with long-term sequelae as well as providing an adjunct discussion on the neurological complications of celiac disease.

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Late clinical manifestation of cerebral tuberculomas in two children with tuberculous meningoencephalitis

Abstract: Patients with initially successful treatment of central nervous system tuberculosis should undergo an alert follow-up for the development of late cerebral tuberculomas. Treatment should consist of prolonged courses of antituberculous chemotherapy and high-dose corticosteroids.

Cited by 7 publications

References 9 publications

Clinical and radiological features of symptomatic central nervous system tuberculomas

Clinical and radiological features of symptomatic central nervous system tuberculomas

Multiple Intracranial Tuberculomas Associated With Partial Status Epilepticus and Refractory Infantile Spasms

Case Report of Subacute Cerebellar Ataxia of Adolescence With Long-Term Sequelae

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