Giant Tuberculoma Resembling Brain Tumor in a Child
13 years old child from tribal area of Khyber Pakhtunkhwa presented to us with chief complaints of headache and vomiting for last 3 months with recent onset of aggressive behavior. Patient had normal neu-rological examination except that he had frontal lobe release signs and bilateral papilledema. MRI scan of brain showed a large ring enhancing lesion measuring 5x6x5 cm in the frontal lobe with surrounding edema (Figures 1 – 3). Because of Short history and relevant MRI picture diagnosis of high grade glioma was made. Though there was history of tuberculosis in the family but because of large size of the lesion with short his-tory with no fever or cough the differential of tubercu-loma was not considered before surgery. Routine in-vestigations were unremarkable. Patient was prepared and put on elective list for craniotomy and excision of the lesion. During surgery patient brain was edematous so patient was hyperventilated and mannitol was given before opening the dura. Per operatively the lesion was fibrous, firm and not easily removable as is the case with high grade glioma and gross total resection was not possible because of brain edema and respiratory distress. Biopsy was taken and subtotal resection was performed. Patient was put on ATT and metastastic work up also advised started. Histopathology report showed a caseating granulomatous lesion (Figure 4).
2. Matloob Azam, Nasera Bhatti. Intracranial Tuber-culomas and Caries Spine: An Experience from Chil-dren’s Hospital Islamabad.
3. The Children’s Hospital, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
4. Global Tuberculosis control report: World Health Orga-nization; 2010.
5. World Health Organization, Global Tuberculosis Re-port.
6. Khan JA, Malik A. Tuberculosis in Pakistan: Are we losing the battle? Journal Pakistan Medical Association, 2003; 53 (8): 320-.
7. Wasay M1, Kheleani BA, Moolani MK, Zaheer J, Pui M, Hasan S, Muzaffar S, Bakshi R, Sarawari AR. Brain CT and MRI findings in 100 consecutive patients with intracranial tuberculoma. J Neuroimaging, 2003 Jul; 13 (3): 240-
8. Diagnostic dilemma and therapeutic non-compliance in a case of intracranial tuberculoma
9. M. E. Ellis, M. A. Halim, R. K. Coates’, A. A. Al-Hokail, S. M. Hussain Qadri? and A. El-Yazigls.
10. Departments of Medkine, 1R a&&gy, 2Pz3thologayn d Laboratory Medkine, Wiokyicaland Medica.
11. Diagnosis and treatment of tuberculosis of the central nervous system in children Neeta Naik.
12. Garg RK. Tuberculosis of central nervous system. Post-grad Med J. 1999; 75: 133-40.
Copyright (c) 2018 Pakistan Journal Of Neurological Surgery
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.