Atormac
brintellex
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 1612  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  » Next article
  » Previous article 
  » Table of Contents
  
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
  »  [PDF Not available] *
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  


  In this Article
 »  References

 Article Access Statistics
    Viewed5398    
    Printed100    
    Emailed3    
    PDF Downloaded0    
    Comments [Add]    
    Cited by others 1    

Recommend this journal

   
Year : 1999  |  Volume : 47  |  Issue : 3  |  Page : 247-8

Glioma mimicking a tuberculoma.






How to cite this article:
Srivatsa A, Lakshminarayanan G. Glioma mimicking a tuberculoma. Neurol India 1999;47:247


How to cite this URL:
Srivatsa A, Lakshminarayanan G. Glioma mimicking a tuberculoma. Neurol India [serial online] 1999 [cited 2020 Aug 4];47:247. Available from: http://www.neurologyindia.com/text.asp?1999/47/3/247/1601



CT scan has revolutionized treatment of intracranial space occupying lesions by providing a reasonable percentage of definite diagnosis based on the appearances of the lesion. Of the lesions described, the various manifestations of intracranial tuberculosis have been extensively described.[1] The authors present a case of glioblastoma mimicking a Tuberculoma on CT and clinical presentation.

A 30 year-old patient was admitted with a history of sudden onset seizures lasting few minutes with no post-ictal weakness. There was no prior history of seizures or headaches. On examination he was conscious, oriented and had no focal deficits. CT scan of the brain showed a hypodense lesion with an adjacent mildly hyperdense lesion abutting the frontal horn on the right side. On contrast, the lesion enhanced well peripherally, but intralesional hypodensity persisted. The hyperdense lesion did not show much enhancement. There was grade II perilesional oedema with compression of the ipsilateral ventricle [Figure 1]. In view of the CT findings, the patient was started on anti tubercular drugs. To get a definite diagnosis, a right frontal craniotomy was done. The lesion was subcortical. Macroscopically, it was greyish, mildly vascular and had central necrosis. The cystic lesion was removed till white matter was seen all around. He did well postoperatively. Histopathological examination revealed a glioblastoma multiforme. There was no evidence of AFB or other features suggestive of tuberculosis. He was irradiated and is doing well.

The CT morphology of intracranial tuberculomas has been well documented since 1976.[2] The important manifestations being isodense to hypodense on plain CT with enhancement on contrast. The enhancement may be ring, nodular or disc type. Multiple lesions of probably different characteristics occurring in the same patient have been seen in 15-20%.[3] Peripheral oedema is usually prominent. The case described here had features of multiple lesions and suggested a tuberculoma. Glioblastomas are also usually mixed density lesions with poor margins and enhance irregularly with contrast. Variable enhancement has also has been described viz nodular, annular or mixed.4 These lesions are usually single and multiple lesions though described, are rarely adjacent.[5]

Tuberculomas are known to mimic gliomas. Brismar et al had a large number of patients who were referred for surgery for brain tumours and were finally diagnosed as tuberculomas.[6] In developing countries, it is justified in making a diagnosis of tuberculoma in patients with intracranial mass lesions. Tumours are also known to mimick tuberculomas. There have been various reports of intracranial mass lesions occurring inspite of chemotherapy.[7] When a CT scan shows all features suggestive of a tuberculoma, patient is usually put on antitubercular treatment. However, as in our case, a glioma masquerades as a tuberculoma, valuable time would have been lost with anti tubercular drugs. The authors feel, it is prudent to get a MRI/MRI spectroscopy done in a mass lesion. If MRI is also inconclusive, a stereotaxic or excision biopsy is mandatory. The lesion may be actually a glioma mimicking a tuberculoma.
 

  »   References Top

1.De Castro CC, De Barros NG, Campos ZM et al : CT scans of cranial tuberculosis. Radiol Clin North Am 1995; 33 : 753-769.  Back to cited text no. 1    
2.Leibrock L, Epstein MH, Rybock JD : Cerebral tuberculoma localised by EMR scan. Surg Neurol 1976; 5 : 305.  Back to cited text no. 2    
3.Bhargava S, Tandon PN : Intracranial tuberculomas : A CT study. Br J Radiol 1980; 53 : 935.  Back to cited text no. 3    
4.Thomson JLG : Computerized axial tomography and diagnosis of glioma; a study of 100 consecutive histologically proven cases. Clin Radiol 1976; 29 : 233-235.  Back to cited text no. 4    
5.Kato T, Aida T, Abe H et al : Clinicopathological study of gliomas- a report of three cases; Neurol Med Chir (Tokyo) 1990; 30 : 604-609.  Back to cited text no. 5    
6.Brismar J, Hugosson C, Larsson SG et al : Imaging of tuberculosis Ill- Tuberculosis as a mimicker of brain tumour. Acta Radiol 1996; 37 : 496-505.  Back to cited text no. 6    
7.Nozaki H, Toyoda T, Takashima S et al : CT findings of six cases with intracranial tuberculosis in National Higashi-Saitama Hospital; Kekkaku 1992; 67 : 383-392.  Back to cited text no. 7    

 

Top
Print this article  Email this article
Previous article Next article
Online since 20th March '04
Published by Wolters Kluwer - Medknow