Isolated brainstem tuberculomas.

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Background:

• Isolated brainstem tuberculomas are rare, accounting for up to 5% of intracranial tuberculomas in endemic regions.
• Diagnosis and management of these lesions present unique challenges, with limited reported data.
• This study aims to clarify management strategies, prognosis, and the impact of advanced imaging on brainstem tuberculomas.

Purpose of the Study:

• To illustrate the complexities in managing isolated brainstem tuberculomas.
• To define the prognosis for patients with brainstem tuberculomas.
• To demonstrate how newer imaging modalities can influence management approaches.

Main Methods:

• A retrospective review of 14 patients diagnosed with isolated brainstem tuberculoma between 2011 and 2015.
• Diagnosis was established by integrating clinical history, physical examination, and imaging findings.
• Treatment involved a 6-week course of steroids and a minimum of 18 months of antitubercular therapy (ATT), with treatment duration guided by clinical recovery and lesion resolution.

Main Results:

• The study included 14 patients (9 males, mean age 24.7 years) with brainstem tuberculomas, predominantly in the pons.
• Common symptoms included cranial nerve deficits and pyramidal weakness; all patients were HIV-negative.
• Eight patients achieved complete lesion resolution, while others continued ATT; mean ATT duration for resolution was 22 months, with significant clinical improvement observed in almost all patients.

Conclusions:

• A high index of suspicion is crucial for diagnosing intracranial tuberculomas, particularly in endemic areas.
• Diagnosis relies on a combination of clinical presentation, investigations, and imaging; biopsy is associated with high complication rates.
• Antitubercular therapy offers a favorable prognosis for brainstem tuberculomas, although extended treatment durations may be necessary.