Calcified intracranial tuberculomas as sequelae of pediatric neurotuberculosis

Tuberculomas calcificados intracranianos como sequela de neurotuberculose pediátrica

A 29-year-old woman with a history of neurotuberculosis at the age of 18 months presented with seizures, abnormal gait, and fluctuations of consciousness level, recovering after anti-tuberculosis treatment. She remained asymptomatic for the next years, except for moderate cognitive impairment. Years later, a brain magnetic resonance imaging (MRI) scan (Figure 1) revealed calcified lobulated masses in the brain parenchyma and basal cisterns.

Figure 1
Magnetic resonance imaging shows multiple lobulated masses with low signal in T1-weighted (A) and T2-weighted (B and C images in the brain parenchyma and basal cisterns, with low signal in susceptibility-weighted imaging (SWI) (D) and phase images (E), compatible with calcifications. Lesions are non-enhancing in post-gadolinium images (F), except for a few peripheral enhancing foci (arrows), corresponding to small vessels.

Intracranial tuberculomas occur in 5–24% of pediatric neurotuberculosis¹ and can be secondary to pial vessel inflammation, perivascular abscesses, or septic emboli². Medical history and the characterization of non-enhancing, diffusely calcified brain masses are important clues for diagnosing residual granulomas.

References

• ¹
  Chiang SS, Khan FA, Milstein MB, Tolman AW, Benedetti A, Starke JR, et al. Treatment outcomes of childhood tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis. 2014 Oct;14(10):947-57. https://doi.org/10.1016/S1473-3099(14)70852-7
  » https://doi.org/10.1016/S1473-3099(14)70852-7
• ²
  Rock RB, Olin M, Baker CA, Molitor TW, Peterson PK. Central nervous system tuberculosis: pathogenesis and clinical aspects. Clin Microbiol Rev. 2008 Apr;21(2):243-61. https://doi.org/10.1128/CMR.00042-07
  » https://doi.org/10.1128/CMR.00042-07

Publication Dates

• Publication in this collection
  19 Mar 2021
• Date of issue
  Feb 2021

History

• Received
  08 June 2020
• Reviewed
  19 July 2020
• Accepted
  25 July 2020