Tuberculoma intracerebral en gestante inmunocompetente / Intracerebral tuberculosis in pregnant immunocompetent

La tuberculosis causada por la bacteria Mycobacterium tuberculosis, se encuentra entre las 10 primeras causas de mortalidad a nivel mundial; la presentación extrapulmonar se produce por siembra vía hematógena o linfática desde un foco primario, correspondiendo a la afectación de sistema nervioso central el 5% de infecciones por TB y se presenta con menor frecuencia en personas inmunocompetentes. Las formas de tuberculosis de SNC son meningitis, tuberculosis espinal y tuberculomas que corresponden al 1% de infecciones por TB. El tratamiento se basa en la terapia antifímica, reservando el manejo neuroquirúrgico para puntuales indicaciones como deterioro neurológico, hidrocefalia o mala respuesta al tratamiento farmacológico.

Tuberculosis, caused by the Mycobacterium tuberculosis bacteria, is among the top 10 cau-ses of mortality worldwide; The extrapulmonary presentation is produced by hematogenous or lymphatic seeding from a primary focus, 5% of TB infections corresponding to central nervous system involvement and occurs less frequently in immunocompetent people. The forms of CNS tuberculosis are meningitis, spinal tuberculosis and tuberculomas that corres- pond to 1% of TB infections. The treatment is based on antifungal therapy, reserving neurosurgical management for specific indications such as neurodeterioration, hydrocephalus or poor response to pharmacological treatment

Tuberculoma cerebral en paciente joven inmunocompetente / Cerebral tuberculoma in young immunocompetent patient

RESUMEN La tuberculosis con afección del sistema nervioso central es una afectación infrecuente pero muy grave de esta enfermedad, representa el 1% de todos los casos de tuberculosis. Reportamos el caso de una joven HIV negativa, con daño del sistema nervioso central de tipo miliar a nivel cerebral y sin enfermedad pulmonar. La tuberculosis puede afectar extensamente a sujetos inmunocompetentes y este fenómeno ha sido descripto en muchas series a los largo del tiempo. Ante la sospecha clínica, el seguimiento de un protocolo específico para confirmar el diagnóstico es de vital importancia para el temprano diagnóstico y correcto manejo de una situación que puede comprometer la vida y generar a largo plazo secuelas graves. Se presenta el caso por el reto diagnóstico que ha supuesto y rara presentación en paciente inmunocompetente.

ABSTRACT Tuberculosis with central nervous system involvement is an uncommon but very serious disease, with a frecuence of 1% of all cases of tuberculosis. We report the case of a young HIV negative woman, with central nervous system damage of the miliary type in the brain without lung disease. Tuberculosis can extensively affect immunecompetent subjects and this phenomenon has been described in many series over the time. In the presence of clinical suspicion, the follow-up of a specific protocol to confirm the diagnosis is of vital importance for the early diagnosis and correct management of a situation that can compromise life and generate long-term serious sequelae. The case is presented because of diagnostic challenge and a rare presentation in an immunocompetent patient.

Comparison between solitary and multiple intracranial tuberculoma

To compare and analyze the clinical, radiological, and pathological features of solitary or/and multiple CNS tuberculomas [CNSTs]. The study was conducted at Central South University, First Xiangya Hospital, Changsha, Hunan, China between 1998-2008. Forty-two subjects with diagnosed CNSTs were compared and analyzed by multiple or solitary lesions seen on enhanced MRI. The final diagnosis of tuberculomas was confirmed by histopathology. From the 42 subjects, 64.3% multiple CNSTs were observed, out of which, 55.6% were with meningitis and 44.4% without meningitis. Of the CNSTs, solitary lesions were present in 35.7%, 80% of which were without meningeal involvement, and 20% with meningeal involvement. In multiple CNSTs, 55.6% were noncaseating granulomas, and 74.1% caseating granulomas with a solid center, while in solitary CNSTs, 80% were caseating granulomas with a solid center. For multiple lesions, temporal lobe, frontal lobe, cerebella, and brain stem were predilection sites. While for solitary lesions, apical lobe, and cerebellum were predilection sites. The histopathological features were the same in all multiple and solitary lesions. Multiple CNSTs are more often associated with meningitis, while solitary CNSTs particularly occur with less or atypical clinical manifestation. Difference in the predilection sites between multiple and solitary CNSTs were observed

A retrospective study of 1247 cases of intracranial tuberculomata diagnosed by computerized tomography.

Tuberculomata in the brain are a common feature of intracranial tuberculosis, especially in the sub-continent. With the advent of computerized tomography, a diagnosis can be made, in many instances. In this study, 1247 cases of CT diagnosed intracranial tuberculomata were analysed retrospectively with regard to the age, sex and symptoms of the patient as well as the number, site and distribution of the lesion within the brain. Tabulation with respect to age revealed that patients with ages ranging from 1-30 years accounted for 60% of the cases. The male to female ratio was approximately 60:40. The parietal hemisphere accounted for 46.75% of the cases. Left sided lesion were more common when compared with the right (statistically significant). We postulate that this increased occurrence of left sided lesions is due to the hematogenous mode of infection and increased blood flow to the dominant hemisphere.