Brain-stem tuberculoma. An analysis of 11 patients
O. Talamas, O. H. Del Brutto and G. Garcia-Ramos
Division de Neurologia, Instituto Nacional de Neurologia y Neurocirurgia, Mexico City, DF.
The clinical and radiologic findings in 11 patients with brain-stem
tuberculoma were reviewed. Clinical manifestations included various
combinations of focal signs and symptoms of subacute onset, similar to
those produced by other space-occupying lesions of the brain stem. Evidence
of systemic tuberculosis was found in six cases (55%). Computed tomography
(CT) usually showed an isodense or hyperdense brain-stem mass with abnormal
contrast enhancement; associated supratentorial granulomas were found in
four cases, and hydrocephalus was found in two cases. Magnetic resonance
imaging showed irregular brain-stem lesions with long T1 and short T2
relaxation times. Cerebrospinal fluid findings were also nonspecific, as
smears for acid-fast bacilli were most often negative. An incorrect
diagnosis of pontine glioma was made in one patient. In contrast, proper
integration of data from CT and magnetic resonance imaging findings,
cerebrospinal fluid analysis, and x-ray films of the chest permitted an
accurate diagnosis in ten cases. Prompt therapy with antituberculous drugs
resulted in clinical improvement, documented by CT, in most patients.
Brain-stem tuberculoma should be suspected in patients with space-occupying
lesions of the brain stem who live in geographic areas where tuberculosis
is endemic. Early diagnosis and prompt medical therapy are important in
preventing mortality and reducing morbidity.
