Brain Tuberculomas

Intracranial Tuberculoma

An intracranial tuberculoma originates by haematogenous spread from tuberculous lesions in other parts of the body, especially the lung. Tuberculomas are frequently multiple and are predominantly located in the posterior fossa in children and young adults, but may occur throughout the cerebral hemispheres.

The clinical presentation is similar to an intracreanial tumour, with features of raised intracranial pressure, focal neurological signs and epileptic seizures, systemic symptoms of tumberculosis, such as fever, excessive perspiration and lethargy, occur in less than 50% of cases.

The CT scan appearance of a tuberculous granuloma is an area of low attenuation with a contrast-enhancing capsule. There is usually surrounding oedema and the lesions may be multiple. The tuborculoma is occasionally calcified.

The pre-operative diagnosis is usually appreciated only after recognition of tuberculous foci elsewhere in the body.

The optimal treatment is surgical excision of the tuberculoma, if it is in a surgically accessible region, and antituberculous chemotherapy.