Tuberculous infection of the brain is quite common. TB can affect brain and spine in a number of ways- tuberculous meningitis, tuberculoma, brain abscess, Pott’s spine, etc. Brain tuberculoma are commonly seen in India. The patients with tuberculoma of brain present with seizures and focal neurological deficits. Here, I am presenting a 35-year old man who presented with seizures and right sided weakness & numbness. MRI brain showed multiple tuberculoma: 1. Left side of pons, 2. Left thalamus, internal capsule and lentiform nucleus. There was significant mass effect and perilesional edema. Figures 1 and 2 demonstrate these findings.
The patient was started on 4-drug anti-tuberculous treatment (isoniazid, rifampin, pyrazinamide and ethambutol), along with oral prednisolone. Levetiracetam was started for seizures. He was asked to come for review after three months. Patient had clinically improved on follow up. His motor power was normal, however, mild right-sided numbness was present. He was seizure-free. Repeat MRI showed significant reduction in the size of tuberculoma as well as in mass effect and perilesional edema (Figures 3 and 4).
Although doing biopsy is ideal to confirm the diagnosis of tuberculoma prior to starting medical treatment, however, in some cases, empirical treatment is the best, if lesions are located in eloquent areas, as in this case.