Radiological Follow-up of a Cerebral Tuberculoma with a Paradoxical Response Mimicking a Brain Tumor.
10.3340/jkns.2015.57.4.307
- Author:
Jeong Kwon KIM
1
;
Tae Young JUNG
;
Kyung Hwa LEE
;
Seul Kee KIM
Author Information
1. Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, Korea. jung-ty@chonnam.ac.kr
- Publication Type:Case Report
- Keywords:
Brain;
Paradoxical;
Tuberculoma;
Tumor
- MeSH:
Aged;
Brain;
Brain Neoplasms*;
Diagnosis;
Edema;
Female;
Follow-Up Studies*;
Glioma;
Headache;
Humans;
Lung;
Magnetic Resonance Imaging;
Occipital Lobe;
Paresis;
Perfusion;
Pons;
Thorax;
Tuberculoma*;
Tuberculosis
- From:Journal of Korean Neurosurgical Society
2015;57(4):307-310
- CountryRepublic of Korea
- Language:English
-
Abstract:
We report a case of a paradoxical response of a tuberculoma in the brain mimicking a brain tumor. A 76-year-old woman presented with a 2 week history of headache, dysarthia, and orthopnea. Brain magnetic resonance images (MRI) revealed two rim-enhancing lesions on the pons and occipital lobe, and chest computed tomography showed randomly distributed miliary nodules. The tentative diagnosis was tuberculosis (TB) of the brain and lung. She complained of right hemiparesis and worsening general weakness after taking the anti-TB medication. On the monthly follow-up images, the enhanced lesions were enlarged with increased perfusion and choline/creatinine ratio, suggesting a high grade glioma. A surgical resection was completed to diagnose the occipital lesion, and the tuberculoma was pathologically confirmed by a positive TB-polymerase chain reaction. The anti-TB medication was continued for 13 months. A follow-up MRI showed decreased size of the brain lesions associated with perilesional edema, and the clinical symptoms had improved. Brain tuberculoma could be aggravated mimicking brain malignancy during administration of anti-TB medication. This paradoxical response can be effectively managed by continuing the anti-TB drugs.
