Intracranial tuberculoma. Evaluation and treatment

We used computerized tomography (CT) to screen 83 patients with partial seizures who had 1) increased intracranial pressure; 2) evidence of systemic tuberculosis; or 3) focal neurological deficit. We found intracranial tuberculoma in 20 (24%). In addition, of 55 patients with tuberculous meningitis, 12 had associated tuberculoma. The image morphology on CT scans showed ring lesions (14), discs (10), and irregular coalescing masses (8). Perilesional edema frequently was present. After appropriate antitubercular therapy, clinical outcome for seizures, neurological deficit, and increased intracranial pressure was satisfactory. CT lesions regressed within 12 weeks of inauguration of medical therapy in most patients. Medical management of tuberculoma is advocated, with surgery limited to those in whom such treatment is ineffective.