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[Cystic cerebral tuberculoma--a case report]
Abstract:
A case of cystic cerebral tuberculoma is presented. A 63-year-old man was admitted initially to a sanatorium in May, 1983, for the treatment of pulmonary tuberculosis. He developed headache and vomiting, and suddenly had a right hemiconvulsion on September 27, 1983. Gradually he developed right hemiparesis and motor aphasia. CT scan revealed a well defined, ring-like enhanced mass with multiloculated cysts in the left fronto-parietal lobe. So, he was transferred to our hospital on February 3, 1984. Neurological examination revealed that he had motor aphasia and right hemiparesis. Left carotid angiogram showed light tumor stain in the left fronto-parietal lobe, and 99mTc brain scan detected increased uptake in this area. A left fronto-parieto-temporal craniotomy was performed and a subcortical mass was excised en bloc. The mass had multiloculated cysts containing xanthochromic fluid. Histologically, the mass was cystic cerebral tuberculoma. Cystic cerebral tuberculomas have rarely been reported even before the introduction of antituberculous chemotherapy. The pathogenesis of the cysts in this particular case was considered that the caseous material would have undergone liquefaction by enzymes liberated from degenerated and fragmented inflammatory cells.
Insights
This case study presents a rare instance of cystic cerebral tuberculoma in a 63-year-old man with pulmonary tuberculosis. Surgical excision confirmed the diagnosis, highlighting a rare manifestation of central nervous system tuberculosis.
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.