[Cystic cerebral tuberculoma--a case report]

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Background:

• Cerebral tuberculomas are rare manifestations of extrapulmonary tuberculosis.
• Cystic variants are exceptionally uncommon, particularly before the widespread use of antituberculous chemotherapy.
• Pulmonary tuberculosis serves as a common source for central nervous system involvement.

Observation:

• A 63-year-old male with treated pulmonary tuberculosis presented with neurological deficits including headache, vomiting, hemiconvulsion, hemiparesis, and motor aphasia.
• Computed Tomography (CT) revealed a ring-enhancing lesion with multiloculated cysts in the left fronto-parietal lobe.
• Cerebral angiography and technetium-99m brain scan indicated abnormal vascularity and increased uptake in the affected area.

Findings:

• Surgical excision of the subcortical mass revealed multiloculated cysts filled with xanthochromic fluid.
• Histopathological examination confirmed the diagnosis of cystic cerebral tuberculoma.
• The pathogenesis is hypothesized to involve liquefaction of caseous material by inflammatory cell enzymes.

Implications:

• This case underscores the importance of considering tuberculosis in the differential diagnosis of brain lesions, even in cystic forms.
• Early diagnosis and surgical intervention are crucial for managing symptomatic cerebral tuberculomas.
• Understanding the pathogenesis of cystic formation may aid in future diagnostic and therapeutic strategies for neurotuberculosis.