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[Multiple cerebral tuberculomas presenting with paradoxical expansion: a case report]
K Gotoh1, I Nishiura, N Nagata
1Division of Neurosurgery, Takeda General Hospital, 28-1 Moriminami-cho, Ishida, Fushimi-ku, Kyoto 601-1415, Japan.
No Shinkei Geka. Neurological Surgery
|January 5, 2002
Summary
This study reports a successful treatment for multiple brain tuberculomas that initially grew larger during therapy. Continuous chemotherapy combined with surgery effectively managed these paradoxical expansions.
Area of Science:
- Neurology
- Infectious Diseases
- Oncology
Background:
- Tuberculosis can manifest in the brain as tuberculomas, posing diagnostic and therapeutic challenges.
- Paradoxical expansion of tuberculomas during treatment is a rare but recognized phenomenon.
Observation:
- A 24-year-old male on antituberculous drugs presented with intracranial tuberculomas showing paradoxical expansion.
- Magnetic Resonance Imaging (MRI) revealed multiple enhancing lesions with significant surrounding edema.
- Surgical resection and polymerase chain reaction confirmed tuberculomas.
Findings:
- Lesions responded differently to chemotherapy; one decreased, while another in the basal ganglia initially grew.
- The growing lesion eventually decreased after 28 months of continuous antituberculous chemotherapy.
- Combined surgical intervention and prolonged chemotherapy led to successful management.
Implications:
- This case highlights the importance of sustained chemotherapy for paradoxical tuberculoma expansion.
- A multimodal approach combining surgery and extended chemotherapy can be effective in managing complex intracranial tuberculomas.
- Understanding and managing paradoxical reactions are crucial for optimizing tuberculosis treatment outcomes.