Tuberculoma masquerading as a meningioma

Abstract

Intracranial tuberculomas may imitate, both clinically and radiologically, the more commonly observed intracranial tumors. This case report outlines the development of such a lesion masquerading as a typical meningioma of the frontal fossa. Discussion of intracranial tuberculomas follows, with special reference to clinical and radiological findings.

Multiple Meningeal Tuberculomas Recurring After 18-Month Anti-tuberculous Chemotherapy-Case Report-

“…2) In previously reported cases with meningeal tuberculoma, CT and MR imaging were unable to differentiate the lesions from meningioma and surgery was required for diagnosis. 1,3,4,8,12,14) Our patient manifested paradoxical worsening that was overcome by the continuation of anti-tuberculous treatment. Paradoxical worsening of clinical and laboratory findings despite appropriate antituberculous therapy has been described in both pulmonary and extrapulmonary tuberculosis.…”

“…Fewer than 50% of patients present with extraneural disease or a past history of tuberculosis, so the diagnosis of brain tuberculoma may be delayed. Furthermore, since most intracranial tuberculomas manifest as intraaxial lesions and very seldom as dural-based masses, 1,[3][4][5]8,[12][13][14] the diagnosis of meningeal tuberculomas is usually established at the time of surgical excision. We treated a patient with multiple meningeal tuberculomas, which manifested with unusual clinical and neuroradiological features, including recurrence as tuberculous meningitis despite 18-month administration of anti-tuberculous therapy.…”

Tuberculoma Mimicking Falx Meningioma-Case Report-

“…Symptoms and signs of intracerebral tuberculoma include raised intracranial pressure as well as focal neurological signs and seizures. 2,5,6,10) However, general symptoms such as fever or malaise are uncommon. 2,5,6) Concomitant extracranial tuberculous infection is present in 30% to 50% of cases, 2) with about 33 1) -50% 2) having no abnormality by chest radiography.…”

“…Angiography may show vascularization of the mass, which is supplied by branches of the middle meningeal artery. 2,4,9,10) One feature that differentiates tuberculoma from others is the isointensity and marked perifocal edema on T 2 -weighted images. 10) The differential diagnosis includes metastatic brain tumor, brain abscess, malignant lymphoma, and granuloma.…”

“…Therefore, the diagnosis of tuberculoma is based on the results of all examinations. 2,5,10) Tuberculoma in the first stage of formation (pregranulomatous stage) appears as low density without enhancement by CT, 1,11) and hypo-or isointense on T 1 -weighted images and isointense on T 2 -weighted images. 1,3,4,10) Tuberculoma that has proceeded to the granulomatous stage with central necrosis, a cheesy necrotic lesion, appears as isodense or slightly hyperdense with a central lowdensity area by CT, 1,6) with uniform enhancement by contrast medium, 5,11) and iso-or hypointense on T 1 -weighted images, 1,3) with uniform enhancement of the central necrosis by gadolinium, [4][5][6]10) and isointense on T 2 -weighted images.…”