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.
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 neurotuberculosis11. 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)70...
and can be secondary to pial vessel inflammation, perivascular abscesses, or septic emboli22. 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...
. Medical history and the characterization of non-enhancing, diffusely calcified brain masses are important clues for diagnosing residual granulomas.
References
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1Chiang 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 -
2Rock 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
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Publication in this collection
19 Mar 2021 -
Date of issue
Feb 2021
History
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Received
08 June 2020 -
Reviewed
19 July 2020 -
Accepted
25 July 2020