[Suprasellar space-occupying lesion as initial manifestation of tuberculosis in childhood]

Three days after having sustained a mild trauma to the head a seven-year-old boy developed seizure-like rotatory vertigo. Computed tomography, magnetic resonance imaging and cerebral angiography demonstrated a suprasellar space-occupying lesion. Pulmonary tuberculosis was discovered in subsequent diagnostic work-up. Cerebrospinal fluid examination was unremarkable except for immunological tests (tuberculostearic acid) which pointed to central nervous system (CNS) involvement so that a tuberculoma was suspected. The lesion decreased in size on tuberculostatic treatment (200 mg/d isoniazid, 200 mg/d rifampicin, two times 250 mg/d pyrazinamide). In the next 12 months there merely persisted a mild abnormality of the blood-brain barrier with a little contrast-medium uptake, which regressed in the following 6 months. The differential diagnosis between CNS tuberculosis and brain tumour or pyogenic abscess can be difficult in children if there are no pulmonary signs and/or the cerebrospinal fluid is normal.