Pseudodementia due to intracranial tuberculomas: an unusual presentation

Vaish, Arvind Kumar; Jain, Nityanand; Gutch, Manish; Yadav, Himanshu

doi:10.1136/bcr.10.2011.4966

Cited by 1 publication

(2 citation statements)

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“…Her cognitive and mood changes had in fact been prodromal symptoms of her central nervous system infection. A similar case report published in 2011 points out that while slow onset, gradual cognitive changes are atypical in TM, any cognitive change in a young person warrants further investigation 7. In our case, a better understanding of her normal abilities and cognitive function prior to presentation, may have aided earlier diagnosis.…”

Section: Discussionsupporting

confidence: 60%

“…Diagnosis can be difficult with demonstration of acid-fast bacilli (AFB) in the cerebrospinal fluid (CSF) being the gold standard but this test has poor sensitivity 6. Other CSF findings can suggest TM in the context of patient history7 and MRI may be helpful in suspected cases 8 9. In this patient, prodromal symptoms presented as subtle cognitive and mood changes, hyponatremia developed as a complication, and MRI was helpful for diagnosis pending definitive laboratory confirmation.…”

Section: Introductionmentioning

confidence: 95%

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Severe hyponatremia and MRI point to diagnosis of tuberculous meningitis in the Southwest USA

Benson

Narasimhamurthy²

2013

BMJ Case Reports

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A 21-year-old woman presented to the hospital with 3 days of headache, fever, mood disturbance and nausea. She had recently emigrated from India, and was noted to have a positive screening purified protein derivative tuberculosis skin test with normal chest x-ray. Meningeal signs were noted prompting lumbar puncture and initiation of presumptive treatment for bacterial meningitis. While tuberculous meningitis (TM) was entertained at admission, diagnosis was clouded by the rapid onset of symptoms and recent major psychosocial stressors. She developed severe hyponatremia. Brain MRI revealed tuberculomas, and she was started on treatment for TM, a diagnosis confirmed by culture. On review, several lessons were learned: (1) globalisation of society makes uncommon diagnoses present in unlikely locations, (2) hyponatremia is a common complication of TM, (3) MRI can aid in diagnosis of TM and (4) cognitive and mood changes can be prodromal symptoms of TM.

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Section: Discussionsupporting

confidence: 60%