TUBERCULOMA

Tuberculoma is the commonest cause of ICSOL in Indian children, which may be solitary or multiple. While most tuberculomas are supratentorial, infratentorial lesions of cerebellum or brain stem are not uncommon.

Pathogenesis: Tuberculomas denote gradual evolvement of parenchymal Rich's focus as chronic inflammatory

Diagnosis rests on typical CT/MRI findings, i.e. solitary or multiple, discrete, ring-enhancing lesions with surrounding cerebral edema and often associated with basal meningitis (Fig. 18.15). CSF is normal (d/d TBM).

Treatment includes: (a) specific antitubercular therapy as per NTEP guidelines, e.g. 2 HRZE + 10 HRE in drug­sensitive cases, (b) steroids for first 4-6 weeks, and (c) prophylactic anticonvulsants. Specific therapy needs to be modified as per drug/sensitivity/resistance profile after reports. Some cases need CSF shunt surgery.

Outcome depends on the response to specific therapy. Despite successful treatment, these lesions may persist for many months or years and may get calcified.

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