Brain stem tuberculosis in children

Tubercular meningitis and intracranial tuberculomas are the two frequent manifestations of neurotuberculosis with their variable incidence in different countries. Brain stem tuberculomas are even more unusual, accounting for 2.5-8% of all intracranial tuberculomas. We present here six paediatric cases of brain stem tuberculosis, where well-formed tuberculomas were demonstrated in five symptomatic cases; however, only a hypodense ill-defined lesion was found in the brain stem of one child who presented with features of tubercular meningitis. Three of these children had other associated tuberculomas in their brain parenchyma as well. All the six cases, however, showed the involvement of 3rd, 6th & 7th cranial nerves, in various combinations, at the time of initial presentation. Only two children developed hydrocephalus and required CSF diversion. All responded well to anti-tubercular chemotherapy, though two children developed toxicity to the therapy, which recovered with drug manipulation for about 2 months. Recovery was full without residual deficit in all the cases. Surgical excision of brain stem granulomas was not indicated in any case.