Unusual Periventricular Hemorrhage as the Initial Manifestation of Central Nervous System Tuberculosis

Intracranial hemorrhage (ICH) is a rare complication of central nervous system (CNS) tuberculosis, and intratuberculoma hemorrhage is even more rare. To the best of our knowledge, periventricular hemorrhage caused by CNS tuberculosis has not yet been reported. In the present report, we have described the peculiar neuroradiological manifestations of periventricular hemorrhage secondary to CNS tuberculosis and discussed the possible mechanisms of intratuberculoma hemorrhage supported by the neuroradiological findings.

We have reported the case of a 50-year-old man who had presented with headache. The initial computed tomography (CT) scan had shown periventricular hematoma with intraventricular hemorrhage. Despite conventional treatment of ICH, his headache deteriorated and repeated CT scan revealed expansion of the hematoma. Further investigation demonstrated CNS tuberculosis and tuberculomas lying within the periventricular hematoma.

ICH can present as the initial manifestation of CNS tuberculosis, and CNS tuberculosis should be suspected when hemorrhage has occurred at an unusual site or the hematoma has expanded despite conventional treatment.