Intracranial tuberculous granuloma

Changed by Henry Knipe, 4 Sep 2015

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Intracranial tuberculous granulomas (also known as CNS tuberculomas) are common in endemic areas, and may occur either in isolation or along with with tuberculous meningitis.

Epidemiology

The epidemiology of patients with tuberculomas is the same as that of other CNS manifestations of TB (see CNS tuberculosis)

Radiographic features

MRI

T1
- isointense to grey-matter ¹
- may have central region of hyperintensity representing caseation
T2
- isointense to grey-matter
- may have central region of hypointensity representing gliosis and abundant monocyte infiltration ¹
- lesions are surrounded by vasogenic oedema
T1 C+ (Gd)
- usually appears as ring-enhancement
- may appear as a conglomerate enhancing mass
DWI
- typically central low signal (i.e. no restricted diffusion) ³ but if liquid necrosis is present centrally may be high signal
MR spectroscopy
- decrease in NAA/Cr
- slight decrease in NAA/Cho
- lipid-lactate peaks are usually elevated (86%) ²

Differential diagnosis

The differential of tuberculomas is essentially is the differential of ring-enhancing lesions, and includes:

Central isointensity or hypointensity compared to grey matter seen centrally on T2 is helpful, as it is not seen in most other causes ¹.

~~-<li>lesions are surrounded by <a title="vasogenic oedema" href="/articles/vasogenic-cerebral-oedema">vasogenic oedema</a>~~
+<li>lesions are surrounded by <a href="/articles/vasogenic-cerebral-oedema">vasogenic oedema</a>
+DWI<ul><li>typically central low signal (i.e. no restricted diffusion) 3 but if liquid necrosis is present centrally may be high signal</li></ul>
+</li>
+<li>

References changed:

3. Castillo M. The Core Curriculum. Lippincott Williams & Wilkins. (2002) ISBN:0781736641. <a href="http://books.google.com/books?vid=ISBN0781736641">Read it at Google Books</a> - <a href="http://www.amazon.com/gp/product/0781736641">Find it at Amazon</a>

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