Pediatric intracranial tuberculoma: illustrative case
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Published on: April 21, 2014
Eva Liu1, Pramath Kakodkar2, Henry Pan2
1Departments of1Neurosurgery.
Background:
Tuberculosis is an airborne disease caused by Mycobacterium tuberculosis. Intracranial tuberculoma is a rare complication of extrapulmonary tuberculosis due to hematogenous spread to subpial and subependymal regions. Intracranial tuberculoma can occur with or without meningitis.
Observations:
A 3-year-old male who had recently emigrated from Sudan presented to the emergency department with right-sided seizures lasting 30 minutes, which were aborted with levetiracetam and midazolam. Head computed tomography revealed a multilobulated left supratentorial mass with solid and cystic components and measuring 8.0 × 4.8 × 6.5 cm. The patient had successful resection of the mass, which was positive for M. tuberculosis. He was started on rifampin, isoniazid, pyrazinamide, ethambutol, and fluoroquinolone and was discharged home in stable condition.
Lessons:
A literature review on pediatric intracranial tuberculoma was performed, which included 48 studies (n = 49). The mean age was 8.8 ± 5.4 years with a slight female predilection (59%). Predominant solitary tuberculomas (63%) were preferentially managed with both resection and antituberculosis therapy (ATT), whereas multifocal tuberculomas were preferentially managed with ATT. Intracranial tuberculoma is a rare but treatable cause of space-occupying lesions in children. Clinicians should maintain a high level of suspicion in patients from endemic regions and involve the infectious disease service early.
Insights
Pediatric intracranial tuberculoma, a rare complication of tuberculosis, presents as a space-occupying lesion. Early suspicion and treatment, including surgery and antituberculosis therapy, are crucial for favorable outcomes in children.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Tuberculosis (TB) is an airborne illness caused by Mycobacterium tuberculosis.
- Intracranial tuberculoma is a rare manifestation of extrapulmonary TB, resulting from hematogenous spread.
- It can manifest with or without tuberculous meningitis.
Purpose of the Study:
- To review the literature on pediatric intracranial tuberculoma.
- To analyze treatment strategies and outcomes for this rare condition in children.
Main Methods:
- A comprehensive literature review was conducted, encompassing 48 studies with 49 pediatric cases.
- Data on patient demographics, clinical presentation, management, and outcomes were analyzed.
Main Results:
- The mean age of affected children was 8.8 ± 5.4 years, with a slight female predominance (59%).
- Solitary tuberculomas were often treated with surgical resection and antituberculosis therapy (ATT), while multifocal lesions primarily received ATT.
- A case of a 3-year-old male with a large supratentorial mass is presented, successfully treated with resection and ATT.
Conclusions:
- Intracranial tuberculoma is a rare but treatable cause of pediatric space-occupying brain lesions.
- High clinical suspicion is warranted in children from endemic regions.
- Early consultation with infectious disease specialists is recommended for optimal management.
