1/59. Pulmonary miliary tuberculosis with multiple intracerebral tuberculous granulomas--report of two cases.Although intracerebral tuberculomas are common in countries where tuberculosis is still endemic, miliary tuberculosis with involvement of the central nervous system is exceptionally rare. We report two cases of pulmonary miliary tuberculosis with multiple intracerebral tuberculomas.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
2/59. role of stereotactic aspiration in the management of tuberculous brain abscess.BACKGROUND: Intracranial tuberculous abscesses are uncommon clinical entities, even in countries where tuberculosis is endemic. Surgical excision and antituberculous treatment is the treatment of choice. The role of stereotactic aspiration in the management of these lesions is highlighted in this communication. methods: Three patients, all receiving treatment for pulmonary tuberculosis, presented with symptoms of raised intracranial pressure and neurological deficits. Computed tomography (CT) scans revealed cystic lesions with enhancing rim in the thalamus in two patients and multiple coalescing cystic lesions in the deep temporal region in another. RESULTS: Stereotactic aspiration of the cyst and biopsy of the cyst wall were performed in all. In two, the pus revealed acid fast bacilli (AFB). In another, though the pus did not reveal any AFB, the wall showed tuberculous granuloma. Antituberculous treatment was continued in all the patients. Follow-up CT revealed resolution of the lesions in all patients. CONCLUSION: Stereotactic aspiration is an useful alternative modality of management of tuberculous abscesses in a selected group of patients.- - - - - - - - - - ranking = 2.0069159380722keywords = brain (Clic here for more details about this article) |
3/59. Metastatic adenocarcinoma masquerading as basal pontine tuberculoma.Tuberculous infection of the central nervous system is common in hong kong. A 39-year-old woman presented with isolated right sixth nerve palsy which was non-progressive for 10 months. Neuro-imaging revealed a right pontine lesion. cerebrospinal fluid (CSF) examination showed lymphocytic meningitis with negative bacteriological and cytological studies. Empirical antituberculous drugs with initial corticosteroid resulted in improved CSF parameters. A diagnosis of cerebral tuberculoma complicated by meningitis was made. She subsequently deteriorated clinically and radiologically. Despite a number of clinical features which were atypical of leptomeningeal metastasis, adenosquamous carcinoma was found on biopsy. Her relatively indolent clinical course might be due to the initial corticosteroid treatment. This report illustrates the importance of early tissue diagnosis in uncertain cases of chronic lymphocytic meningitis.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
4/59. Rapid improvement of intracranial tuberculomas after addition of ofloxacin to first-line antituberculosis treatment.Reported here is the case of a 9-year-old girl presenting with disseminated tuberculosis, the manifestations of which included mediastinal adenopathy, an osteolytic parietal lesion with a large associated scalp abscess, cerebral empyema, meningoencephalitis, and tuberculomas. No clear improvement was observed after 4 weeks of first-line antituberculosis treatment (10 mg/kg rifampin, 15 mg/kg isoniazid, 30 mg/kg ethambutol, 30 mg/kg pyrazinamide). The isolation of an isoniazid-resistant organism prompted institution of ofloxacin. Introduction of this drug was associated with dramatic improvement. Its good penetration into the central nervous system and its distribution into macrophages suggest that this drug may be of interest for the treatment of intracranial tuberculomas, particularly those due to isoniazid-resistant strains.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
5/59. neurocysticercosis like presentation in a case of CNS tuberculosis.A clinical picture consisting of seizures, multiple non-tender subcutaneous nodules, and multiple 'nodular or ring' enhancing lesions in computed tomography of the brain is considered characteristic of neurocysticercosis in an endemic area. 1,2 A case with a similar clinical picture, in whom serological tests and histopathological examination of subcutaneous nodule established tuberculosis as a cause, is presented.- - - - - - - - - - ranking = 0.50172898451804keywords = brain (Clic here for more details about this article) |
6/59. Case report: one-and-a-half-syndrome and tuberculosis of the pons in a patient with AIDS.A patient with advanced AIDS presented with right conjugate gaze palsy and impaired adduction on left gaze (the one-and-a-half syndrome). The responsible pontine lesion involved the ipsilateral abducens nucleus and the adjacent medial longitudinal fasiculus (MLF), as demonstrated by magnetic resonance imaging (MRI). tuberculosis (TB) was the etiology of the brainstem lesion. The patient had complete recovery after anti-tuberculosis treatment. The nuclear location of the tuberculoma is unusual and the reversal of this neuro-ophthalmologic syndrome is noteworthy.- - - - - - - - - - ranking = 0.50172898451804keywords = brain (Clic here for more details about this article) |
7/59. Composite pituitary adenoma and intrasellar tuberculoma: report of a rare case.Tuberculous involvement of the pituitary gland is rare. We report a unique case of a composite lesion consisting of pituitary adenoma and intrasellar tuberculoma. A 24-year-old lady presented with features of acromegaly and amenorrhea. serum growth hormone levels were found to be raised. Radiological investigations were consistent with a pituitary adenoma. decompression of the lesion was done through trans-sphenoidal approach. Histological examination revealed a growth hormone secreting pituitary adenoma in association with a granulomatous lesion suggesting of pituitary tuberculoma. No other evidence of tuberculosis was found in the brain or spinal cord. This type of dual pathology has been reported only once in the earlier literature.- - - - - - - - - - ranking = 0.50172898451804keywords = brain (Clic here for more details about this article) |
8/59. Possible role of adjunctive thalidomide therapy in the resolution of a massive intracranial tuberculous abscess.We present the case of a young child who developed a massive tuberculous abscess of the posterior fossa while being treated for pulmonary tuberculosis. Clinical improvement after surgical excision of the abscess was followed by recurrence of symptoms of acutely raised intracranial pressure on standard antituberculosis and corticosteroid therapy. Magnetic resonance (MR) imaging of the brain showed that a multiloculated abscess had developed anterior to the excision site of the original abscess. The recurring abscess was partly excised and drained but could not be removed completely because of its proximity to the brain stem. thalidomide, a potent inhibitor of tumour necrosis factor alpha (TNF-alpha), was added to the treatment regimen and resulted in marked clinical improvement with resolution of the abscess within 4 months. The remaining CT lesion had the appearance of a small granuloma. Both the clinical and the radiological response was maintained after 1 year of antituberculosis treatment.- - - - - - - - - - ranking = 1.0034579690361keywords = brain (Clic here for more details about this article) |
9/59. Focal limb dystonia in a patient with a cerebellar mass.BACKGROUND: Focal dystonia of acute onset is indicative of a structural lesion in the nervous system. Cerebellar lesions have rarely been associated with dystonia. CASE DESCRIPTION: A 42-year-old woman was admitted to the neurology ward because of fever, confusion, and gait unsteadiness. She was diagnosed as having tuberculous meningitis, and, after a few days of antituberculous treatment, she developed prominent dystonia of the left upper limb. Cranial nuclear magnetic resonance imaging showed an isolated lesion compatible with a tuberculoma in the left cerebellar hemisphere. Both the limb dystonia and the tuberculoma resolved with maintained antituberculous treatment. CONCLUSIONS: In the patient described, the presence of upper-limb dystonia ipsilateral to a focal cerebellar lesion and the resolution of the dystonia and the mass lesion following treatment suggest that the cerebellum or its connections to the thalamus and/or basal ganglia could be involved in the pathophysiology of the dystonia.- - - - - - - - - - ranking = 0.24686183416787keywords = nervous system (Clic here for more details about this article) |
10/59. cavernous sinus tuberculoma: diagnostic difficulties in a personal case.BACKGROUND: tuberculoma of the brain is rare, and its location in the cavernous sinus is exceptional. Many factors make the diagnosis difficult, necessitating a surgical procedure. CASE DESCRIPTION: A 44-year-old woman complained of persistent headaches and diplopia. The examination revealed a right cavernous sinus syndrome. Radiologic investigation showed a growing process in the right cavernous sinus, overlapping the sella turcica. The diagnoses of metastasis, tuberculoma, and sarcoidosis were considered, but none of them could be confirmed. A biopsy of the lesion via a subtemporal approach revealed a tuberculoma. Antituberculous treatment led to complete resolution of her symptoms. CONCLUSION: The diagnosis of a cavernous sinus tuberculoma is difficult; it is confirmed by biopsy. However, a trial of medical treatment, if the results are favorable, may obviate the need for a surgical procedure.- - - - - - - - - - ranking = 0.50172898451804keywords = brain (Clic here for more details about this article) |
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