Presentation
Headache and ataxia.
Patient Data
Multiple (about four) space occupying lesions are seen in the right cerebellum, left frontal and right parietal parafacalcine regions. The largest lesion is in the right cerebellum. The lesions elicit isointense signal on T1 with hyperintense margins, low signal on T2/FLAIR WI. Characteristic hypointense margins on susceptibility weighted imaging are noted. On post-contrast series they show peripheral rim enhancement.
The lesions are surrounded by mild vasogenic edema.
The patient underwent surgical excision of the right cerebellar lesion which is pathologically proven case of tuberculoma. The patient received antituberculous therapy for 2 months, then presented for follow up.
Surgical excision of the right cerebellar space occupying lesion associated with area of encephalomalacia, gliosis and irregular linear enhancement at the operative bed, representing post-operative changes.
Regression of the size of the left frontal and right parietal lesions.
Case Discussion
This case illustrates the typical features of intra-cranial tuberculomas with characteristic low signal on T2/FLAIR WI, peripheral hypointense rim on SWI and peripheral rim enhancement post-contrast.