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Brainstem tuberculoma in the immunocompetent: case report and literature review.

Abstract
Brainstem tuberculoma is an uncommon entity especially in the immunocompetent adult. The authors describe the case of a 32-year-old immunocompetent woman with no systemic signs or symptoms of tuberculosis, presenting with sudden-onset hemiparesis and diplopia. MRI of brain revealed an enhancing lesion in the midbrain and thalamus. Cerebrospinal fluid examination was normal. Chest imaging was consistent with miliary tuberculosis; however initial expectorated sputum was culture negative. Bronchosopy sputum culture was positive for Mycobacterium tuberculosis. Her PPD was negative. Patient became asymptomatic with treatment for tuberculosis and follow-up MRI showed complete resolution of the lesion a year later. We conclude that a high index of suspicion is essential to make an early diagnosis of intracranial tuberculoma, since often, traditional TB tests like PPD and sputum examinations can be negative.
AuthorsSoma Sahaiu-Srivastava, Brenda Jones
JournalClinical neurology and neurosurgery (Clin Neurol Neurosurg) Vol. 110 Issue 3 Pg. 302-4 (Mar 2008) ISSN: 0303-8467 [Print] Netherlands
PMID18160211 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Antitubercular Agents
Topics
  • Adult
  • Antitubercular Agents (therapeutic use)
  • Brain Stem (pathology)
  • Bronchoscopy
  • Female
  • Humans
  • Immunocompetence
  • Magnetic Resonance Imaging
  • Sputum (microbiology)
  • Tegmentum Mesencephali (pathology)
  • Thalamus (pathology)
  • Tuberculin Test
  • Tuberculoma, Intracranial (drug therapy, pathology)
  • Tuberculosis, Miliary (complications, pathology)

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