Tuberculoma of the brain: a series of 16 cases treated with anti-tuberculosis drugs.

OBJECTIVES

To describe the clinical presentation, radiological findings and outcome of treatment with antituberculosis drugs in 16 cases of intracranial tuberculoma.

DESIGN

Consecutive cases admitted with tuberculoma to the National Center for Neurological Diseases in Khartoum, Sudan, were included in the study. The diagnosis was based on clinical and neuro-imaging features and response to anti-tuberculosis treatment. Histopathology of material from the brain or other extracranial tissues was available in seven cases.

RESULTS AND CONCLUSIONS

The commonest presenting features were headache (100%), generalized convulsions (68.7%) and hemiparesis (56.2%). Computerised axial tomography/magnetic resonance imaging (CT/MRI) showed single or multiple lesions that showed intense contrast enhancement and perilesional edema. The lesions completely cleared on anti-tuberculosis treatment in the majority of survivors (13/15). Partial clearance of lesion was associated with late presentation, multiple large lesions and advanced miliary disease. We advocate early empirical trial of anti-tuberculosis drugs for intracranial tuberculoma even after a presumptive diagnosis, particularly in areas where the infection is endemic.