Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Department of Neurology, Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department, and National Key Discipline, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Backgrounds: Tuberculoma is a granulomatous inflammatory process mimicking a neoplasm, both clinically and radiologically. Although those with an infratentorial origin are rare, this disease is still a diagnostic challenge using conventional workup. However, this disease should not be overlooked because it is essentially curable with proper diagnosis and therapy, usually, a Mycobacterium Tuberculosis (MTB) DNA test is performed. Methods: We retrospectively analyzed the clinical presentations, CSF results, and images of 11 MTB DNA positive and clinically cured cases of infratentorial tuberculoma. Results: Infratentorial tuberculoma usually deteriorated before antituberculosis treatment (ATT). Magnetic resonance imaging showed space-occupying lesions without specific features, 4 within the cerebellum and 7 within the brainstem. Evidence of systemic tuberculosis was found in only 1 case. Clinical manifestations included various combinations of focal signs and symptoms in the brain stem and cerebellum. Cerebrospinal fluid (CSF) findings were also nonspecific. The diagnoses of these cases were based on the positive tests of a nested polymerase chain reaction (N-PCR) assay. Trial therapy with antituberculous drugs resulted in clinical improvement, as documented by MRI in all patients. Conclusions: Infratentorial tuberculoma should be suspected in patients with infratentorial space-occupying lesions who live in geographic areas where tuberculosis is endemic.
N. Guo, F. Huang, X. Chen, M. Zheng, D. Zhong and Y. Feng, "Infratentorial Tuberculoma Mimics Tumor in Immunocompetent Adults: An Analysis of 11 Patients," Open Journal of Modern Neurosurgery, Vol. 3 No. 3, 2013, pp. 36-40. doi: 10.4236/ojmn.2013.33008.
[1] A. Cherian and S. V. Thomas, “Central Nervous System Tuberculosis,” African Health Sciences, Vol. 11, No. 1, 2011, pp. 116-127. [2] P. F. Barnes, A. B. Bloch, P. T. Davidson and D. E. Snider Jr., “Tuberculosis in Patients with Human Immunodeficiency Virus Infection,” The New England Journal of Medicine, Vol. 324, No. 23, 1991, pp. 1644-1650. doi:10.1056/NEJM199106063242307 [3] M. R. Gropper, M. Schulder, H. L. Duran and L. Wolansky, “Cerebral Tuberculosis with Expansion into Brainstem Tuberculoma,” Journal of Neurosurgery, Vol. 81, No. 6, 1994, pp. 927-931. doi:10.3171/jns.1994.81.6.0927 [4] H. M. Dastur and A. D. Desai, “A Comparative Study of Brain Tuberculomas and Gliomas Based on 107 Case Records of Each,” Brain, Vol. 88, No. 2, 1965, pp. 375-396. doi:10.1093/brain/88.2.375 [5] S. I. Poonnoose, S. Singh and V. Rajshekhar, “Giant Cerebellar Tuberculoma Mimicking a Malignant Tumor,” Neuroradiology, Vol. 46, No. 2, 2004, pp. 136-139. doi:10.1007/s00234-003-1148-0 [6] S. Sathyanarayana, M. K. Baskaya, M. Fowler, R. Roberts and A. Nanda, “Solitary Tuberculoma of the Cerebellopontine Angle: A Rare Presentation,” Journal of Clinical Neuroscience, Vol. 10, No. 1, 2003, pp. 120-122. doi:10.1016/S0967-5868(02)00269-2 [7] S. Sahaiu-Srivastava and B. Jones, “Brainstem Tuberculoma in the Immunocompetent: Case Report and Literature Review,” Clinical Neurology and Neurosurgery, Vol. 110, No. 3, 2008, pp. 302-304. doi:10.1016/j.clineuro.2007.11.002 [8] R. Kumar, R. Jain, A. Kaur and D. K. Chhabra, “Brain Stem Tuberculosis in Children,” British Journal of Neurosurgery, Vol. 14, No. 4, 2000, pp. 356-361. doi:10.1080/026886900417397 [9] H. Sugimori, Y. Saku, S. Ibayashi, T. Ogasawara, M. Fujishima and M. Iida, “Solitary Pontine Tuberculoma,” Internal Medicine, Vol. 41, No. 9, 2002, pp. 738-742. doi:10.2169/internalmedicine.41.738 [10] Y. Q. Feng, N. Guo, F. Huang, X. Chen, Q. S. Sun and J. X. Liu, “Anti-Tuberculosis Treatment for Devic’s Neuromyelitis Optica,” Journal of Clinical Neuroscience, Vol. 17, No. 11, 2010, pp. 1372-1377. doi:10.1016/j.jocn.2010.02.023 [11] Y. Q. Feng, “Infratentorial Tuberculoma Mimics Tumor in Immunocompetent Adults: An Analysis of 11 Patients,” Journal of Cancer Science & Therapy, 2012. [12] A. Unal and P. N. Sutlas, “Clinical and Radiological Features of Symptomatic Central Nervous System Tuberculomas,” European Journal of Neurology, Vol. 12, No. 10, 2005, pp. 797-804. doi:10.1111/j.1468-1331.2005.01067.x [13] G. Sonmez, E. Ozturk, H. O. Sildiroglu, H. Mutlu, F. Cuce, M. G. Senol, A. Kutlu, C. C. Basekim and E. M. R. I. Kizilkaya, “Findings of Intracranial Tuberculomas,” Clinical Imaging, Vol. 32, No. 2, 2008, pp. 88-92. doi:10.1016/j.clinimag.2007.08.024 [14] K. Mazodier, E. Bernit, V. Faure, et al., “Central Nervous Tuberculosis in Patients Non-HIV: Seven Case Reports,” La Revue de Médecine Interne, Vol. 24, No. 2, 2003, pp. 78-85. doi:10.1016/S0248-8663(02)00715-4 [15] C. Bayindir, O. Mete and B. Bilgic, “Retrospective Study of 23 Pathologically Proven Cases of Central Nervous System Tuberculomas,” Clinical Neurology and Neurosurgery, Vol. 108, No. 4, 2006, pp. 353-357. doi:10.1016/j.clineuro.2005.03.001 [16] A. Bouchama, M. Z. Al-Kawi, I. Kanaan, R. Coates, A. Jallu, B. Rahm and E. B. Siqueira, “Brain Biopsy in Tuberculoma: The Risks and Benefits,” Neurosurgery, Vol. 28, No. 3, 1991, pp. 405-409. doi:10.1227/00006123-199103000-00011 [17] O. Talamás, O. H. Del Brutto and G. García-Ramos, “Brain-Stem Tuberculoma. An Analysis of 11 Patients,” Archives of Neurology, Vol. 46, No. 5, 1989, pp. 529-535. doi:10.1001/archneur.1989.00520410063025 [18] H. U. Qureshi, S. N. Merwat, S. A. Nawaz, A. A. Rana, A. Malik, M. K. Mahmud, A. Latif, A. Khan and A. R. Sarwari, “Predictors of Inpatient Mortality in 190 Adult Patients with Tuberculous Meningitis,” Journal of Pakistan Medical Association, Vol. 52, No. 4, 2002, pp. 159-163. [19] S. Haldar, N. Sharma, V. K. Gupta and J. S. Tyagi, “Efficient Diagnosis of Tuberculous Meningitis by Detection of Mycobacterium Tuberculosis DNA in Cerebrospinal Fluid Filtrates Using PCR,” Journal of Medical Microbiology, Vol. 58, No. 5, 2009, pp. 616-624. doi:10.1099/jmm.0.006015-0 [20] Y. Feng, N. Guo, J. Liu, X. Chen, Q. Sun, R. Lai and F. Huang, “Mycobacteria Infection in Incomplete Transverse Myelitis Is Refractory to Steroids: A Pilot Study,” Clinical and Developmental Immunology, Vol. 2011, 2011, Article ID: 501369. doi:10.1155/2011/501369 [21] V. C. Cheng, P. L. Ho, R. A. Lee, et al., “Clinical Spectrum of Paradoxical Deterioration during Antituberculosis Therapy in Non-HIV-Infected Patients,” European Journal of Clinical Microbiology & Infectious Diseases, Vol. 21, No. 11, 2002, pp. 803-809. doi:10.1007/s10096-002-0821-2 [22] V. Asselman, F. Thienemann, D. J. Pepper, A. Boulle, R. J. Wilkinson, G. Meintjes and S. Marais, “Central Nervous System Disorders after Starting Antiretroviral Therapy in South Africa,” AIDS, Vol. 24, No. 18, 2010, pp. 2871-2876. doi:10.1097/QAD.0b013e328340fe76