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[Multiple intracranial tuberculomas in infancy].

M Serrano1, J Campistol, B Chávez

  • 1Servicio de Neurología; Hospital Sant Joan de Déu, Esplugues de Llobregat, 08950, España.

Revista De Neurologia
|September 20, 2001
PubMed
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Intracranial tuberculomas can develop in children after tuberculous meningitis treatment, even without prior signs. Early detection and management are crucial for better outcomes in pediatric neurotuberculosis.

Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Neuroimaging

Background:

  • Central nervous system (CNS) tuberculosis is most common in children, presenting as meningoencephalitis, basal arachnoiditis, or intracranial tuberculomas.
  • Intracranial tuberculomas constitute approximately 3% of neurotuberculosis cases and are more prevalent in adults than children.
  • Advancements in Computed Axial Tomography (CAT) and Magnetic Resonance (MR) imaging have significantly improved the diagnosis of CNS tuberculosis complications.

Observation:

  • A 5-month-old patient with tuberculous meningitis, initially treated successfully with standard anti-tuberculosis drugs, developed triventricular hydrocephalus requiring a ventriculoperitoneal shunt.
  • Three months post-shunt insertion, the patient experienced intracranial hypertension. Cranial CAT revealed hypodense parenchymal areas, and MR imaging showed multiple, disseminated, T2-hyperintense lesions consistent with intracranial tuberculomas.

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  • Despite a second shunt insertion, the patient had residual right hemiparesia and developmental delay.

    • Findings:

    • Intracranial tuberculomas, though typically seen in adults, can manifest in children following meningoencephalitis.
    • Tuberculomas may emerge after an initial positive response to tuberculostatic therapy, often within the first three months of treatment.
    • The development of these tuberculomas is hypothesized to result from the accumulation of immune cells at microscopic foci during treatment initiation.

    Implications:

    • This case highlights the potential for late-onset intracranial tuberculomas in pediatric tuberculous meningitis, even with appropriate treatment.
    • Neuroimaging plays a critical role in diagnosing these complications, necessitating careful monitoring of patients.
    • Understanding the pathogenesis of tuberculoma formation post-treatment is essential for refining therapeutic strategies and improving long-term neurological outcomes in children.