Presentation
Recent convulsions.
Patient Data
Right temporal subcortical space-occupying lesion of abnormal signal. It elicits isointense/ slightly hyperintense signal on T1 WI, low signal on T2 WI with faint marginal diffusion restriction, and marginal post-contrast enhancement. Small nodular lesions are surrounding the large lesion. The lesions are surrounded by subcortical vasogenic edema signal and exert a positive mass effect in the form of effacement of the overlying cortical sulci.
The patient tested positive for sputum acid-fast bacillus (AFB) and Genexpert for tuberculosis.
CSF analysis revealed high protein, low glucose and positive for AFB.
A CT scan of the chest was performed to detect pulmonary tuberculosis.
Right upper lobar apical consolidative patch showing air bronchogram and a large cavity, surrounded by small nodular and tree-in-bu densities. Bilateral small scattered pulmonary nodules are also noted.
Right mild pleural effusion with underlying relaxation collapse of the right lower lung lobe.
Multiple pathologically enlarged mediastinal retrocaval, paratracheal, prevascular, aortopulmonary, and subcarinal lymph nodes.
Case Discussion
The young age of the patient as well as some radiological features such as low T2 signal intensity of the lesion, marginal post-contrast enhancement, and smaller ring-enhancing nodules surrounding the large lesion, are all suggestive of cerebral tuberculoma, which was confirmed by laboratory and CT chest assessment which revealed consolidative patches, cavitary lesion, and tree-in-bud densities.
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