Serial Morphologic Changes on Magnetic Resonance Imaging in a Brainstem Tuberculoma after Antituberculous Treatment

Serial Morphologic Changes on Magnetic Resonance Imaging in a Brainstem Tuberculoma after Antituberculous Treatment

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Abstract Incidence of tuberculosis (TB) is decreasing all over the world due to improved diagnosis and treatment.Though central nervous system TB accounts for 1% of all TB cases, it carries high mortality and neurologic morbidity.Surgery is difficult when eloquent areas of brain are involved, particularly brainstem.Even with Mountaineering - Accessoires advent of magnetic resonance imaging (MRI) facilities and serologic tests, definitive diagnosis is difficult.

We report a case of a 57-year-old-woman with possible brainstem TB, diagnosed based on initial MR images.She was empirically started on anti-TB medications followed by serial repeat MR images at 5, 12, and 19 months interval.The initial MR images revealed a thick ring-enhancing lesion, which showed progressive reduction in size, became irregular thin-walled ring-enhancing lesion at 5 months, uniform ring-enhancing lesion at 12 months, and small solid nodular enhancement at 19 months follow-up.There was Kids clothes gradual improvement in neurologic status, and the patient became asymptomatic at the end of 1 year.

Characteristic MRI changes over a period favoring adequate response to antituberculosis treatment aids in strengthening presumptive diagnosis of brainstem tuberculoma in resource-poor countries.Along with presumptive diagnosis and timely initiation of medical therapy, periodic MRI follow-up is important in preventing mortality and reducing morbidity.