Three patients with intracranial tuberculomas with unusual features

Thrush, D. C.; Barwick, D D

doi:10.1136/jnnp.37.5.566

Cited by 50 publications

(22 citation statements)

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“…A paradoxical response to the antitubercular chemotherapy in brain tuberculoma is rare but an established entity since its first report by Thrush and Barwick [12], and till now approximately 41 such cases have been reported in the literature. The largest series of 10 cases was reported by Teoh et al [13].…”

Section: Discussionmentioning

confidence: 99%

“…Unlike pulmonary tuberculosis, the paradoxical progression of intracranial tuberculomas during the treatment of neurotuberculosis has been recognized as a rare response to antitubercular chemotherapy. In the literature, more than 41 cases have been reported worldwide [1,4,5,6,7,8,9,10,11,12,13,14,15]. We encountered 10 children under 18 years of age, who demonstrated a paradoxical response to antitubercular therapy, where tuberculoma either increased in size or developed during the course of chemotherapy.…”

Section: Introductionmentioning

confidence: 98%

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Paradoxical Response to Chemotherapy in Neurotuberculosis

Kumar¹,

Prakash

Jha

2006

Pediatr Neurosurg

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Objective: Our objective was to investigate the paradoxical response and the factors responsible for such an uncommon (but known) response to chemotherapy in neurotuberculosis. Material and Methods: Ten children with intracranial tuberculomas/neurotuberculosis were retrospectively studied, who were on regular antituberculous chemotherapy. Any deterioration of the neurological condition, increase in the size of the lesion or appearance of new lesions was studied clinically and radiologically during the follow-up period. Results: An atypical response to chemotherapy was observed from 3 weeks to 1 year of chemotherapy. Four of the 10 children, who were receiving chemotherapy for either posttubercular meningitis (TBM), hydrocephalus (2) or TBM (2), developed multiple granulomas in 3 and hydrocephalus in 1 case. The remaining 6 children who were diagnosed to have granulomas at their presentation deteriorated at the follow-up despite regular chemotherapy. CT scans were repeated in 7 of 10 cases at the time of neurological deterioration, out of which 5 children showed appearance of new granulomas or abscess(es) and 2 showed an increase in the size of their preexisting granulomas. One patient with faintly enhancing granulomas in the posterior fossa responded to an additional use of steroids. The remaining 9 patients required surgical intervention on account of their neurological deterioration. Conclusions: (1) Paradoxical responses to intracranial tuberculoma/neurotuberculosis can occur at any time even up to 1 year during chemotherapy despite a regular standard antitubercular treatment. (2) New granuloma(s) or abscess(es) may appear in children receiving chemotherapy for TBM during the follow-up. (3) Hydrocephalus may also appear despite a regular chemotherapy in treated TBM cases. (4) Immature faintly enhancing tuberculomas have a more likely chance of resolution with antituberculous chemotherapy and glucocorticoids, while a well-formed and probably large-sized (>3 cm) granuloma may have a risk of paradoxical enlargement.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Paradoxical Response to Chemotherapy in Neurotuberculosis

Kumar¹,

Prakash

Jha

2006

Pediatr Neurosurg

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“…Os tuberculomas cerebrais são, com certa frequência, múltiplos e o número de lesões varia, sendo quase sempre inferior a 10 3-9,12, [14][15][16][17][18]20,[23][24][25][26]29,31,33,[35][36][37]39,40. Num caso relatado por Dastur et al16 havia 22 minúsculos tuberculomas cerebrais, o de maior número de lesões descrito até então na literatura.…”

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“…The patient was a chronic alcoholic and had generalized tuberculosis. The literature on multiple cerebral tuberculomas is reviewed and the neurological clinical picture presented by the patient and the association between generalized tuberculosis and chronic alcoholism arc commented upon.Os tuberculomas cerebrais representam uma das lesões expansivas intracranianas com incidência variável conforme a procedência das séries publicadas.Em países como a Índia, Nigéria, Rodésia, Chile e Brasil foram encontrados índices de 21,5% 16, 12,5%33) 19%27( 15,9%5 e 4,4% 2 5, respectivamente.As incidências menores são observadas nos Estados Unidos e Europa Ocidental, onde constituem menos de 1% das lesões expansivas intracranianas 21,34,41.Os tuberculomas cerebrais são, com certa frequência, múltiplos e o número de lesões varia, sendo quase sempre inferior a 10 3-9,12, [14][15][16][17][18]20,[23][24][25][26]29,31,33,[35][36][37]39,40. Num caso relatado por Dastur et al16 havia 22 minúsculos tuberculomas cerebrais, o de maior número de lesões descrito até então na literatura.…”

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Tuberculomas cerebrais múltiplos: relato de um caso autopsiado com 37 lesões

Pittella

Toppa

1988

Arq. Neuro-Psiquiatr.

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RELATO DE UM CASO AUTOPSIADO COM 37 LESÕES JOSÉ EYMARDHOMEM PITTELLA -NIVALDO HARTUNG TOPPA RESUMO -É descrito caso autopsiado com 37 tuberculomas cerebrais, o de maior número de lesões descrito na literatura. O paciente era alcoólatra crônico e tinha tuberculose generalizada. Faz-se revisão da literatura de tuberculomas cerebrais múltiplos e comenta-se o quadro clínico neurológico apresentado pelo paciente e a associação entre tuberculose generalizada e alcoolismo crônico.Multiple cerebral tuberculomas: report of a post-mortem examined case with 37 lesions.SUMMARY -An autopsied case of multiple cerebral tuberculomas with 37 lesions, the one with the greatest number of lesions described in the literature, is reported. The patient was a chronic alcoholic and had generalized tuberculosis. The literature on multiple cerebral tuberculomas is reviewed and the neurological clinical picture presented by the patient and the association between generalized tuberculosis and chronic alcoholism arc commented upon.Os tuberculomas cerebrais representam uma das lesões expansivas intracranianas com incidência variável conforme a procedência das séries publicadas.Em países como a Índia, Nigéria, Rodésia, Chile e Brasil foram encontrados índices de 21,5% 16, 12,5%33) 19%27( 15,9%5 e 4,4% 2 5, respectivamente.As incidências menores são observadas nos Estados Unidos e Europa Ocidental, onde constituem menos de 1% das lesões expansivas intracranianas 21,34,41.Os tuberculomas cerebrais são, com certa frequência, múltiplos e o número de lesões varia, sendo quase sempre inferior a 10 3-9,12, [14][15][16][17][18]20,[23][24][25][26]29,31,33,[35][36][37]39,40. Num caso relatado por Dastur et al.16 havia 22 minúsculos tuberculomas cerebrais, o de maior número de lesões descrito até então na literatura.Descrevemos caso autopsiado de alcoólatra crônico e com tuberculose generalizada em que foram identificados 37 tuberculomas cerebrais. OBSERVAÇÃO JPS, sexo masculino, 46 anos, alcoólatra crônico, desempregado, procedente do Hospital João XXIII, em Belo Horizonte. O paciente foi admitido naquele hospital queixando-se de cefaléia, tonteiras e diarréia. À admissão informava mal e nada lembrava de sua história pessoal pregressa. O exame físico revelou desnutrição, desidratação, icterícia, ascite e escabiose. Os exames laboratoriais mostraram provas funcionais hepáticas compatíveis a insuficiência hepática.Durante a hospitalização o paciente apresentou três crises convulsivas

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“…These responses are often encountered in three tissues: lymph nodes, brain and lungs [2]. In paradoxical reactions of the brain, some tuberculomas may enlarge [1,3,4,5], or new ones may develop [6,7,8,9]. Steroid therapy with antituberculous chemotherapy is generally recommended for treatment of paradoxical tuberculomas.…”

Section: Introductionmentioning

confidence: 99%

Paradoxical Intracranial Tuberculoma Requiring Surgical Treatment

Baş¹,

Güzey²,

Emel³

et al. 2005

Pediatr Neurosurg

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Paradoxical enlargement of intracranial tuberculomas or development of new ones during adequate antituberculous chemotherapy is an uncommon event. Treatment of such cases is controversial. Steroid therapy is usually advocated without change in the antituberculous drug program. However, in some patients whose lesions fail medical treatment, or who have superficially located large lesions, surgical therapy may be required. A 15-year-old girl with pulmonary miliary tuberculosis, tuberculous meningitis and multiple intracranial tuberculomas is presented. While her pulmonary lesions and intracranial tuberculomas except one were healed with chemotherapy, one tuberculoma increased in size 1 month after starting chemotherapy. She was followed with dexamethasone treatment in addition to antituberculous therapy for 2 months. Then, the lesion was removed because it had increased in size in spite of appropriate chemotherapy.

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Three patients with intracranial tuberculomas with unusual features

Cited by 50 publications

References 8 publications

Paradoxical Response to Chemotherapy in Neurotuberculosis

Paradoxical Response to Chemotherapy in Neurotuberculosis

Tuberculomas cerebrais múltiplos: relato de um caso autopsiado com 37 lesões

Paradoxical Intracranial Tuberculoma Requiring Surgical Treatment

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