MR spectroscopy-aided differentiation: "giant" extra-axial tuberculoma masquerading as meningioma

Tuberculosis is common in the developing world and in developed nations secondary to increasing immunocompromise in the population. It commonly causes meningitis and parenchymal tuberculomas. We present a case of an unusual masslike "giant" extra-axial tuberculoma during pregnancy. Unusual morphology and size at imaging made meningioma a close differential. MR spectroscopy served to complement MR imaging, providing diagnostic confirmation and depicted findings characteristic of a tuberculoma.