Cerebral tuberculosis with expansion into brainstem tuberculoma

Gropper, Mitchell R.; Schulder, Michael; Duran, Harry L.; Wolansky, Leo

doi:10.3171/jns.1994.81.6.0927

Cited by 47 publications

(31 citation statements)

References 25 publications

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“…Los tuberculomas intracraneanos son poco frecuentes en los países desarrollados, pero constituyen el 5% al 30% de todas las masas intracraneanas de los pacientes de algunos países en vías de desarrollo (8 (24,25).…”

Section: Discussionunclassified

Aparición paradójica de tuberculomas encefálicos durante el tratamiento de tuberculosis en pacientes inmunocompetentes.

Lizarazo

2004

biomedica

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Se presentan dos casos de aparición de tuberculomas encefálicos durante el tratamiento de tuberculosis en pacientes inmunocompetentes. El primero, un hombre adulto que presentó una lesión frontal derecha que requirió cirugía y el segundo, una niña con múltiples lesiones, localizadas principalmente en el tallo cerebral. Los dos pacientes evolucionaron satisfactoriamente con el tratamiento. Esta paradójica presentación de la tuberculosis se atribuye a una rara interacción inmunológica entre el huésped y el bacilo tuberculoso. Los pacientes con esta patología no requieren cambio en el tratamiento antituberculoso y los esteroides son de utilidad en el alivio sintomático. La cirugía se reserva para aquellos casos de hipertensión endocraneana incontrolable o cuando hay incertidumbre diagnóstica. El pronóstico de esta patología es generalmente bueno.Palabras clave: tuberculoma, sistema nervioso central, tuberculosis, inmunidad. Paradoxical appearance of encephalic tuberculomas during treatment for tuberculosis in immunocompetent patientsTwo cases of appearance of encephalic tuberculomas during anti-tuberculous treatment in immunocompetent patients are presented. The first an adult man presenting a right frontal lesion which required surgical treatment and the second a girl with multiple lesions located mainly in the brainstem. This paradoxical presentation is attributed to a bizarre immunological reaction between the host and the tuberculosis bacillus. Patients with this condition do not require changes in anti-tuberculous treatment, and steroids are helpful in alleviating the symptoms. Surgery is indicated only for cases of uncontrollable intracranial hypertension or when there is diagnostic uncertainty. The prognosis of this entity is usually good.

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Section: Discussionunclassified

Aparición paradójica de tuberculomas encefálicos durante el tratamiento de tuberculosis en pacientes inmunocompetentes.

Lizarazo

2004

biomedica

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“…Amongintracranial tuberculoma, brainstem tuberculoma is rare and it accounts for 2.5-8% of all intracranial tuberculoma in large series studies (1,2,8). Tuberculoma is formed as a result of hematogenous dissemination of Mycobacterium tuberculosis.…”

Section: Discussionmentioning

confidence: 99%

“…isolated intrinsic pontine tuberculoma accompaniedwith little or no meningeal reaction, are rare, and such reports demonstrate no specific clinical or radiological features (1)(2)(3)(4). Brainstem biopsy harbors certain risks of deadly complications, such as bleeding or meningeal spread of infection, and it may be inappropriate to diagnose tuberculoma that is potentially a benign disease (1,4,5).…”

Section: Introductionmentioning

confidence: 99%

Solitary Pontine Tuberculoma.

et al. 2002

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A 66-year-old man, with a history of pulmonary tuberculosis 40 years before admission, complained of headache and dysarthria that lasted for 2 weeks and was followed by diplopia. MRIrevealed an isolated nodular lesion in the pons with a marked enhancement mimicking brain tumor and other diseases. Antituberculous drugs were started under the presumptive diagnosis of tuberculoma. The lesion was completely resolved after 9 months of treatment and thus, the final diagnosis was confirmed. Anempiric administration of antituberculous drug may be an important and non-invasive diagnostic tool as well as a treatment in such cases. (Internal Medicine 41: 738-742, 2002)

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“…A literatura sugere que os pacientes com suspeita de tuberculose do SNC devem receber um curso prolongado de terapia antituberculosa, com associação de pelo menos 4 drogas (rifampicina, isoniazida, pirazinamida e etambutol) durante um período de 12 a 30 meses, mesmo após o desaparecimento dos sintomas 6,10,13,16 . A terapia tuberculostática precoce, além de eficaz, melhora o prognóstico.…”

Section: Fig 3 Ressonância Magnética Do Crânio Após Administração Deunclassified

“…O diagnóstico de neurotuberculose implica na instituição imediata do tratamento tuberculostático com pelo menos 4 drogas, pelo período de 12 a 30 meses, mesmo após o desaparecimento dos sintomas 1,13,14 . O uso de corticosteróides durante 4 a 8 semanas faz parte da terapia coadjuvante, observando-se melhora do quadro clínico naqueles pacientes que desenvolvem hipertensão intracraniana ou cuja lesão apresenta importante efeito de massa.…”

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Múltiplos tuberculomas intracerebrais na vigência de terapia específica para tuberculose pulmonar: a propósito de um caso

Pimentel

Alves²,

Novis

et al. 2000

Arq. Neuro-Psiquiatr.

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RESUMO -A forma clássica de apresentação da neurotuberculose é a meningite. Os tuberculomas cerebrais são formas raras de neurotuberculose e resultam da disseminação hematogênica de focos distantes de infecção pelo Mycobacterium tuberculosis. Aproximadamente 1% dos pacientes com tuberculose do sistema nervoso central desenvolve tuberculomas intracranianos, poucas semanas ou meses após o início da quimioterapia tuberculostática. A involução das lesões é lenta e não necessariamente significa resistência medicamentosa ou falta de aderência ao tratamento. Descrevemos o caso, diagnosticado e tratado na 25ª Enfermaria da Santa Casa da Misericórdia do Rio de Janeiro, de um paciente imunocompetente que apresentou meningite e tuberculomas múltiplos do sistema nervoso central, durante o tratamento específico de tuberculose miliar. A literatura é revisada e o diagnóstico, terapêutica e possíveis mecanismos imunológicos são discutidos. PALAVRAS-CHAVE: tuberculoma, tuberculose miliar, quimioterapia tuberculostática. Intracranial tuberculomas developing during treatment of pulmonary tuberculosis: case reportABSTRACT -The classical presentation of neurotuberculosis is meningitis. Intracranial tuberculomas are a rare manifestation of neurotuberculosis and are due to hematogenous dissemination of distant focuses of Mycobacterium tuberculosis infection. Around 1% of patients with central nervous system tuberculosis develop intracranial tuberculomas some weeks or months after the beginning of the specific treatment with tuberculostatic chemotherapy. The involution of the lesions is slow and does not mean drug resistance nor lack of adequate treatment. We describe the case, diagnosed and treated at the 25 th Infirmary of Santa Casa da Misericórdia do Rio de Janeiro, of an immunocompetent male patient who developed meningitis and multiple intracranial tuberculomas during the specific treatment of miliary tuberculosis. The literature is revised and the diagnosis, treatment and possible immunological mechanisms are discussed.

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Cerebral tuberculosis with expansion into brainstem tuberculoma

Cited by 47 publications

References 25 publications

Aparición paradójica de tuberculomas encefálicos durante el tratamiento de tuberculosis en pacientes inmunocompetentes.

Aparición paradójica de tuberculomas encefálicos durante el tratamiento de tuberculosis en pacientes inmunocompetentes.

Solitary Pontine Tuberculoma.

Múltiplos tuberculomas intracerebrais na vigência de terapia específica para tuberculose pulmonar: a propósito de um caso

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