Atypical response to chemotherapy in neurotuberculosis

Five cases of intracranial tuberculosis with atypical response to antitubercular chemotherapy are reported. In these cases tuberculomas either increased in sizes or first developed during course of adequate chemotherapy for tubercular meningitis or postmeningitic hydrocephalus. In two of these cases granulomas were located deeply in the parenchyma; however, these were on the surface in the other three. Atypical response to antitubercular treatment was observed at 5 weeks, 8 weeks, 2 months (in two cases) and 6 months. Glucocorticoid therapy was instituted in two cases and surgical excision of tuberculomas performed in the others. Recovery was good in all the five cases excluding visual loss, which remained unchanged in two cases because of prexisting secondary optic atrophy.