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Tuberculoma


Presentation

  • Abstract This case report describes a rare presentation of presumed brain stem tuberculoma in a 28-year-old male who presented with acute onset of third cranial nerve palsy with contralateral hemiparesis (Weber syndrome) and upgaze palsy.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Tuberculomas were present in 50% of patients, while infarcts were present in 25%. Old age, TBM grading, presence of infarction and hydrocephalus were all predictors of poor outcome. Published by the BMJ Publishing Group Limited.[ncbi.nlm.nih.gov]
  • In the present case, a 45-year-old male patient presented with seizures and headache, a provisional diagnosis of tuberculoma was made on the basis of clinical and CT findings.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: We report a case of a 12-year-old Sudanese boy with trisomy 21 who was presented to our hospital with focal convulsions and right-sided weakness.[ncbi.nlm.nih.gov]
  • Here an atypical case of dural en-plaque tuberculoma is presented with comprehensive review of dural en-plaque lesions with their differentiating features. A 20-year-old man presented with features of increased intracranial pressure.[ncbi.nlm.nih.gov]
Nightmare
  • Shunting in tuberculous meningitis: A surgeon's nightmare. Childs Nerv Syst. 2008; 24 :1029–32. [ PubMed ] [ Google Scholar ] 8. Sütlaş PN, Unal A, Forta H, Senol S, Kirbaş D. Tuberculous meningitis in adults: Review of 61 cases.[ncbi.nlm.nih.gov]
Intravenous Administration
  • The lesions were isodense on CT in 18/25 (72%) of the pre-contrast studies and 21/25 (84%) showed ring or rim enhancement after intravenous administration of the contrast medium.[ncbi.nlm.nih.gov]
Cough
  • We describe the case of a 13-year-old girl, with 3 weeks of progressive tiredness and asthenia and a 48 h fever and cough. Physical examination revealed diminished pulmonary sounds in the left lower hemithorax.[ncbi.nlm.nih.gov]
  • A 22 year old HIV negative Asian woman was diagnosed with tuberculosis (TB) following onset of cough, fevers, and weight loss.[ncbi.nlm.nih.gov]
  • UK Correspondence to: Dr P Dennison Oxford Chest Unit, Churchill Hospital, Oxford OX3 7LJ, UK; paddydennison{at}hotmail.com Statistics from Altmetric.com A 22 year old HIV negative Asian woman was diagnosed with tuberculosis (TB) following onset of cough[doi.org]
  • A 47-year-old female, with multiple comorbidities, presented with a cough of two months, loss of weight and appetite. She was treated for pneumonia. A chest X-ray showed bilateral reticulonodular opacities.[rcpe.ac.uk]
Hemoptysis
  • In the 5 who had symptoms referable to the respiratory system, the chief complaints were dull chest pain, frequent “colds,” chronic cough, fatigue, and, in 2 only, hemoptysis. Bronchoscopy, carried out in 7 cases, was negative.[pubs.rsna.org]
  • Classic symptoms of tuberculosis, like fever, hemoptysis, and weight loss, were uncommon. Chest roentgenographic abnormalities were present in 62 percent of the patients.[ncbi.nlm.nih.gov]
Dysphagia
  • Dysphagia is the primary complaint followed with weight loss, retrosternal pain, odynphagia, and epigastric pain ( 9 ). All patients in this report presented with dysphagia.[ncbi.nlm.nih.gov]
  • Conclusions: ET should be considered as a causative factor for dysphagia. Surgery should be applied in undiagnosed ET. VATS is useful in improving rate of confirmative diagnosis, and relieving symptom of dysphagia.[dx.doi.org]
  • Esophageal tuberculosis is suspected in patients with pulmonary or systemic tuberculosis who later develop dysphagia.[ncbi.nlm.nih.gov]
Retinal Pigmentation
  • It also allows a detailed visualisation of the secondary retinal pigment epithelial and intraretinal changes and is helpful in monitoring the response to medication.[ncbi.nlm.nih.gov]
  • Optical coherence tomography (Fig. 2) showed serous detachment of the neurosensory retina (Fig. 2B) and an area of localized adhesion between the neurosensory retina and retinal pigment epithelial–choriocapillaris layer (contact sign, Fig. 2A).[aao.org]
Hemianopsia
  • Eye examination revealed bitemporal hemianopsia. Brain MRI scan showed a mass in the sella with features suggestive of pituitary adenoma.[ncbi.nlm.nih.gov]
Tinnitus
  • Four months into treatment she developed an occipital headache, tinnitus and diplopia, with papilloedema on examination.[ncbi.nlm.nih.gov]
Myalgia
  • Clinical Features In most children with TBM, there is a prodromal phase of malaise and myalgia lasting for 2-8 weeks prior to the development of symptoms and signs of meningeal irritation.[ncbi.nlm.nih.gov]
Hand Deformity
  • The patient, a 7-year-old girl, presented with swelling over the medial aspect of her right forearm just below the elbow joint, with features of ulnar nerve palsy, including paresthesias along the little and ring fingers and claw hand deformity.[ncbi.nlm.nih.gov]
Flight of Ideas
  • A 53-year-old Colombian woman was admitted to a third-level hospital in Cali, Colombia, after reporting loss of consciousness, headache, paresthesia, and flight of ideas for a two-week period.[ncbi.nlm.nih.gov]
Tremor
  • On examination, he had quadriparesis with a power 4/5 in all four limbs, tremors, dysarthria, dysmetria, dyssynergia, dysdiadochokinesia, hypotonia in all limbs, plantar response was equivocal without sensory involvement.[nnjournal.net]
  • Abnormal movement disorders may occur-choreoform or hemiballistic movements, athetosis, tremors and myoclonic jerks have all been described.[ncbi.nlm.nih.gov]
Quadriplegia
  • He had quadriplegia (muscle power 0 at 4 limbs) and sensory loss below C5 level. He also had incontinence, anal tone loss, and paradoxical respiratory pattern.[ncbi.nlm.nih.gov]
  • […] arachnoiditis, hydrocephalus causing compression of the optic nerves, optic nerve granulomas and ethambutol toxicity may be the cause of blindness in patients with TBM.[ 9, 10 ] Any focal neurological deficit may occur in the limbs, ranging from monoplegia to quadriplegia[ncbi.nlm.nih.gov]
  • […] arachnoiditis, hydrocephalus causing compression of the optic nerves, optic nerve granulomas and ethambutol toxicity may be the cause of blindness in patients with TBM.[ 9 , 10 ] Any focal neurological deficit may occur in the limbs, ranging from monoplegia to quadriplegia[ncbi.nlm.nih.gov]
Bulging Fontanelle
  • Infants become increasingly irritable and develop bulging fontanelles and increasing head circumferences. Nausea, vomiting and altered sensorium may follow in these children. Low-grade pyrexia or “night sweats” are reported in 80% of the patients.[ncbi.nlm.nih.gov]
Monoplegia
  • Optochiasmatic arachnoiditis, hydrocephalus causing compression of the optic nerves, optic nerve granulomas and ethambutol toxicity may be the cause of blindness in patients with TBM.[ 9, 10 ] Any focal neurological deficit may occur in the limbs, ranging from monoplegia[ncbi.nlm.nih.gov]
  • Optochiasmatic arachnoiditis, hydrocephalus causing compression of the optic nerves, optic nerve granulomas and ethambutol toxicity may be the cause of blindness in patients with TBM.[ 9 , 10 ] Any focal neurological deficit may occur in the limbs, ranging from monoplegia[ncbi.nlm.nih.gov]
Myoclonic Jerking
  • Abnormal movement disorders may occur-choreoform or hemiballistic movements, athetosis, tremors and myoclonic jerks have all been described.[ncbi.nlm.nih.gov]

Workup

  • DISCUSSION The workup for an HIV positive patient who presents with altered mental status often focuses on more common etiologies, including toxoplasmosis, bacterial or fungal meningitis, or neurocystercercosis.[westjem.com]
  • Solitary pulmonary nodules: detection, characterization, and guidance for further diagnostic workup and treatment. AJR Am J Roentgenol 2007;188:57-68. [ Crossref ] [ PubMed ] Wang H, Lin H, Jiang G.[jtd.amegroups.com]

Treatment

  • Treatment was prolonged for 24 months because at 12th and 18th months of treatment one of the brain lesions, although significantly smaller, still showed contrast enhancement.[ncbi.nlm.nih.gov]
  • Early diagnosis is imperative, since clinical outcomes are largely dependent on timely treatment.[ncbi.nlm.nih.gov]
  • This case highlights the need to select the initial treatment for pulmonary tuberculoma, not chronic hepatitis C.[ncbi.nlm.nih.gov]
  • Four months into treatment she developed an occipital headache, tinnitus and diplopia, with papilloedema on examination.[ncbi.nlm.nih.gov]

Prognosis

  • Most patients respond well to the anti-TB therapy, but for those with severe spinal cord compression or those irresponsive to the drug therapy, surgical intervention could facilitate neurologic recovery and improve the prognosis.[ncbi.nlm.nih.gov]
  • Hydrocephalus in TBM: Incidence, its predictive factors and impact on the prognosis. J Infect. 2013; 66(4):330–7. Das A, Das SK, Mandal A, Halder AK.[informaticsjournals.com]
  • Early surgical intervention combined with ATT yields good prognosis. References 1. Rhoton EL, Ballinger WE Jr, Quisling R, Sypert GW. Intramedullary spinal tuberculoma. Neurosurgery 1988;22:733-6. 2.[jscisociety.com]
  • Conclusion: When tuberculous pathology is limited to the bone, the prognosis is better than in articular disease, as there is less deformity, and hence, less residual pain and disability.[doi.org]
  • The disease process carries a good prognosis.[westjem.com]

Etiology

  • Final histopathology revealed multiple epithelioid granulomas suggestive of tubercular etiology or intracranial Langerhans cell histiocytosis.[ncbi.nlm.nih.gov]
  • Considering an infectious etiology must be a diagnostic option.[ncbi.nlm.nih.gov]
  • The combination of clinical information and CT findings allowed for precise localization of the lesion and suggested tuberculoma as the possible etiology.[ncbi.nlm.nih.gov]
  • Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China China Medical University Center for Evidence Based Medicine, Shenyang, China Key Laboratory of Cancer Etiology and Intervention, University of Liaoning Province[doi.org]

Epidemiology

  • We will discuss in this report various aspects of this rare disease in term of epidemiology, diagnosis, and treatment.[ncbi.nlm.nih.gov]
  • Epidemiology and Infection 2003 ; 131 : 647 – 654 . 23. Gallay , A , et al. The capture–recapture methods applied to epidemiology: principles, limitations, and applications [in French] .[cambridge.org]
  • Each chapter begins with a shot historical account of the disease, followed by a critical evaluation of the epidemiological and/or hospital based data. This is then compared with the data of other global populations.[books.google.de]
  • Mercer, Updating the epidemiological transition model, Epidemiology and Infection, 10.1017/S0950268818000572, 146, 6, (680-687), (2018). Andrés F.[doi.org]
  • Epidemiological, therapeutic and evolutionary profiles in patients with lymph node tuberculosis. Tuberk Toraks. 2010; 58:366–74. Smith H. Paradoxical responses during the chemotherapy of tuberculosis. J Infect. 1987; 15:1–3.[informaticsjournals.com]
Sex distribution
Age distribution

Pathophysiology

  • This review synthesizes pertinent findings in the literature surrounding central nervous system tuberculoma in an effort to highlight recent advances in pathophysiology, diagnosis, and treatment. Copyright 2013 Elsevier Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • Tuberculous brain abscess: Clinical presentation, pathophysiology and treatment(in children) Childs NervSyst. 2002; 18 :118–23. [ PubMed ] [ Google Scholar ] 17. Andronikou S, Wieselthaler N.[ncbi.nlm.nih.gov]
  • Tuberculomas can develop through four pathophysiological mechanisms. First, invasion of bacilli from the CSF (TB meningitis). Second, as a consequence of a disseminated TB.[scielo.br]

Prevention

  • Our case highlights the need for early confirmation of tuberculoma diagnosis by molecular assay so that timely treatment can be initiated to prevent severe brain damage.[ncbi.nlm.nih.gov]
  • Seite 344 - Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association. ‎[books.google.de]
  • This fact and the present acknowledgment that surgery is the treatment of choice make accurate preoperative diagnosis important, in order to preserve normal lung tissue and to prevent unnecessarily radical procedures.[pubs.rsna.org]
  • The anaesthetic technique chosen should prevent aspiration, avoid fluctuations in intracranial pressure, maintain stable haemodynamics, provide a sufficient depth of anaesthesia and good postoperative analgesia.[ijaweb.org]
  • In some less typical cases, the biopsy may prevent lesion misdiagnosis (e.g meningioma) and prevent the patient from being exposed to the harmful effects of unnecessary therapy [37,38].[sciforschenonline.org]

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