Tuberculoma - Abscesses of the nervous system

Tuberculoma

Definition

A tuberculoma is a localised caseous abscess within the brain caused by M. tuberculosis. It is rare in the West, but the commonest single intracranial lesion in India.

Aetiology/pathophysiology

A tuberculoma is a chronic caseating intracranial granuloma, which may arise from haematogenous spread during primary TB, e.g. miliary TB.

Clinical features

The condition is often asymptomatic as they are rarely large enough to cause symptoms of an intracranial mass lesion. Rupture into the subarachnoid space may cause tuberculous meningitis. A tuberculoma in the brainstem may cause hydrocephalus by obstruction.

Investigations

Lesion may be seen on X-ray as an area of internal calcification, or on CT/MRI. Skin testing, e.g. Mantoux is not reliable.

Management

Anti-tuberculous therapy as for tuberculous meningitis should be used but is often unsuccessful, in which case surgical drainage may be used.