Tuberculomas presenting as isolated intrinsic brain stem masses

Abstract

We document the clinical presentation, management and outcome of histologically verified, solitary, intrinsic brain stem tuberculomas in six patients. The neurological symptoms and signs in these patients did not distinguish their lesions from other intrinsic masses of the brain stem. On contrast-enhanced computed tomography (CT), the tuberculomas appeared as ring enhancing lesions in three patients and nodular contrast enhancing lesions in the other three. Diagnosis was established on the basis of CT-guided stereotactic biopsy in all patients. All patients were treated with antituberculous drugs for 18 months. Steroid therapy of 2-8 weeks duration was also used in four patients. At a median follow-up period of 20 months (range 9-51 months), three patients were asymptomatic and the other three were functioning independently with mild disability. Although isolated, intrinsic brain stem tuberculoma is an uncommon entity, it should be suspected in patients presenting with features of an intrinsic brain stem mass and a contrast-enhancing lesion on CT. CT-guided stereotactic biopsy usually provides evidence of the inflammatory nature of the mass although an aetiological diagnosis is often elusive. Early diagnosis and appropriate therapy with antituberculous drugs and steroids usually results in an excellent or good outcome in most instances.