Intracranial tubercular granuloma
Headache, nausea, vomiting, blurred vision and seizure.
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Multiple ring enhancing lesions which are isointense to gray matter on T1, hypointense on T2 and FLAIR with surrounding vasogenic edema seen involving bilateral precentral gyri, bilateral centrum semiovale and corona radiate, left angular gyrus, bilateral middle frontal gyri, right superior frontal gyrus, left inferior frontal gyrus, left superior and middle temporal gyrus, inferior cerebral peduncle and mid brain.
No blooming on SWI and no hyperintensity on DWI or ADC is noted.
Imaging features and clinical profile of the patient are suggestive of multiple tubercular granulomas.
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This patient is a known case of pulmonary tuberculosis, who has not completed the treatment.
Intracranial tuberculomas are space occupying lesions that result from haematogenous spread of primary infection from a distant focus. Histologically the central iso or hypointense area contains caseous necrosis surrounded by a capsule (enhancing) made up of fibroblasts, epithelioid cells, Langhans giant cells and lymphocytes.
- 1. Vidal JE, Oliveira AC, Dauar RF. Cerebral tuberculomas or tuberculous brain abscess: the dilemma continues. Clin. Infect. Dis. 2005;40 (7): 1072. doi:10.1086/428673 - Pubmed citation
- 2. Kim TK, Chang KH, Kim CJ et-al. Intracranial tuberculoma: comparison of MR with pathologic findings. AJNR Am J Neuroradiol. 1995;16 (9): 1903-8. AJNR Am J Neuroradiol (abstract) - Pubmed citation