Intracranial tuberculomas

Case contributed by Dr Utkarsh Kabra

Presentation

13 year old Indian presenting with seizures.

Patient Data

Age: 13 years
Gender: Female
Modality: MRI

The study reveals multiple focal and conglomerate peripheral rim enhancing lesions with hypointense center on T2w images and mild to moderate perilesional oedema in bilateral cerebellar hemispheres, right frontal, bilateral occipital and left posterior parietal lobes. There is mild mass effect on leftlateral aspects of 4th ventricle. Subtle leptomeningeal enhancement seen at places.

Spectroscopy through the cerebellar lesions show elevated lipid lactate peaks.

Case Discussion

The imaging features, particularly in an endemic area, are almost certainly those of tuberculomas, particularly in view of the T2 hypointense centres.  The differential diagnosis includes neurocysticercosis, however, points that favour the diagnosis of tuberculoma are:

  • no obvious scolex is seen in any of the lesions
  • T2 hypointense core
  • leptomeningeal enhancement
  • presence of conglomerate lesions
  • lipid-lactate peak on MRS
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Case Information

rID: 51955
Case created: 15th Mar 2017
Last edited: 22nd Mar 2017
Inclusion in quiz mode: Included

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