Intracranial Tuberculoma Presenting as Atypical Eclampsia: A Case Report

Abstract

Occurrence of eclampsia before 20 weeks of pregnancy and after 48 hours of delivery in the absence of typical signs of hypertension and or proteinuria is termed as atypical eclampsia. Atypical or non-classic eclampsia will have some symptoms of eclampsia but without the usual proteinuria or hypertension. All patients with atypical onset should undergo neurological evaluation to rule out neurologic causes of seizures. Cerebral tuberculosis is a rare and serious form of disease secondary to haematogenous spread of Mycobacterium tuberculosis. Here we present a case of cerebral tuberculoma with seizures in late pregnancy mimicking eclampsia.

Tuberculous meningoencephalitis associated with brain tuberculomas during pregnancy: a case report

“…The incidence of TB in pregnancy ranges between 1 and 2% [ 13 ]. The diagnosis and management of tuberculoma is an important public health problem in both developing and industrialized nations but unlike pulmonary TB, which has been under close investigation, the diagnosis and treatment of tuberculomas have received little consideration [ 14 ].…”

“…There are only a few case reports of intracerebral tuberculomas during pregnancy (Table 1 ) [ 13 – 15 , 29 – 31 ]. Patients who presented intracerebral tuberculoma during pregnancy were younger than 30 years of age and 57% of them had multiple intracerebral lesions.…”

“…(2015) [ 15 ] 19 years Second trimester Normal delivery Solitary lesion Arumugam et al . (2016) [ 13 ] 24 years Third trimester Normal delivery Solitary lesion Namani et al . Presented case 25 years Second trimester Caesarean section Multiple lesions …”

“…Tuberculomas often present with symptoms and signs of focal neurological deficit without evidence of systemic disease [ 32 ]. They behave like space-occupying lesions and present with signs of raised intracranial pressure, localized neurological deficits, seizures, and even behavioral problems [ 13 ]. Seizures are one of the most common symptoms occurring in up to 85% of cases along with symptoms related to elevated intracranial pressure such as headache, papilledema, and lethargy [ 33 ].…”

“…Our patient presented signs and symptoms of meningoencephalitis and space-occupying lesions: headache, vomiting, fever, altered mental status to soporous state, right hemiparesis, and generalized seizures. A total of 71% of reported cases of intracerebral tuberculomas manifested neurologic deficit and seizures (Table 1 ) [ 13 – 15 , 29 – 31 ]. CSF analysis showed mild mononuclear pleocytosis as in only one of the previously reported cases (28.6%) [ 14 ].…”