The aim of this study was to outline the clinicoradiological features of central nervous system (CNS)
tuberculoma, and highlight the importance of early treatment. We conducted a retrospective analysis between 1999 and 2008. Clinicoradiological, pathological and follow-up data of 23 patients were reviewed and analysed. The mean age at presentation was 30.3 years (range=17-43 years), and the average disease duration at presentation was six months (range=1-19 months). The
tuberculoma location in the cohort was: thoracic region (10 patients); cervical region (six), cervicothoracic region (three); thoracolumbar region (one); and intracranial (six); three patients (13%) had multiple lesions. Nineteen (82.6%) and 15 (65.2%) patients had sensory-motor and bowel/bladder involvement, respectively. Two patients presented with
headache and consciousness disturbance, and two patients had a history of pulmonary
Koch's disease. Five patients had a history of tuberculous
meningoencephalitis, and one patient had a history of enlarged cervical lymph nodes. Twenty-one patients underwent surgery, and two received
conservative treatment; all patients received anti-
tuberculosis therapy for 18 months. Seventeen of the 21 surgical patients and both conservatively managed patients achieved improved neurological function (with Karnofsky Performance Scale scores of 90-100). Patients presenting at an advanced disease stage had a poorer outcome. CNS
tuberculoma is a benign condition with a good prognosis and effective
therapy options. Enhanced brain and spine MRI should be performed to ensure the diagnosis is not missed. Early
surgical decompression is recommended for intramedullary
tuberculoma.
Craniotomy is indicated for patients with
intracranial hypertension, while more
conservative therapy is appropriate for patients who have intracranial
tuberculomas without
intracranial hypertension.