Disease relevance of Tuberculoma

• We report in vivo proton magnetic resonance (MR) spectroscopic findings in three benign infective/inflammatory lesions (one case each of tuberculoma, fungal granuloma, and xanthogranuloma), which showed high choline along with the presence of lipid/lactate, a feature characteristically described in neoplastic lesions [1].
• In conclusion, although steroids may diminish neurologic symptoms and improve outcome, tuberculomas may appear during the course of anti-tuberculosis and steroid treatment [2].
• An unusual case of a hypothalamic tuberculoma is presented in a man, who initially presented with signs and symptoms consistent with panhypopituitarism [3].
• As seizures are common signs of cerebral tuberculomas, but not of meningitis it is possible that tubercular meningitis might have enhanced severe neuropsychiatric side effects of mefloquine [4].
• Clinical presentation and investigations indicate that the probable cause of convulsions could be attributed to cerebral edema (57 per cent), syndrome of inappropriate secretion of antidiuretic hormone (35 per cent), hydrocephalus (32 per cent), tuberculoma (27 per cent), abnormal electric focus (25 per cent), and cerebral infarction (13 per cent) [5].

High impact information on Tuberculoma

• The patient was continued on isoniazid and rifampin, with radiographic resolution of the tuberculoma 4 months later [6].
• Following 9 months of treatment with isoniazid, ethambutol, rifampin, and pyrazinamide, most lesions resolved; however, one cortical tuberculoma enlarged significantly [6].
• Both the limb dystonia and the tuberculoma resolved with maintained antituberculous treatment [7].
• RESULTS: Nine of 10 tuberculomas showed FDG uptake at PET, and the mean peak standardized uptake value was 4.2 +/- 2.2 (SD) [8].
• Though not histologically verified, it seems justified to conclude that in India a ring or disc enhancing lesion is the commonest accompaniment of focal epilepsy, and that at least one third (and probably more) of these lesions are tuberculomas [9].

Chemical compound and disease context of Tuberculoma

• Fluorescein angiographic findings were compatible with the clinical diagnosis of a choroidal tuberculoma [10].
• MT ratios from all the 33 lesions were consistent with tuberculomas while PMRS showed choline along with lipids in 7 predominantly cellular lesions simulating a neoplasm [11].
• After gadolinium-DTPA enhancement, 2 malignant tumors and 7 tuberculomas showed a marginal rim enhancement pattern, whereas 15 malignant tumors and 2 tuberculomas revealed a diffuse enhancement [12].
• Among the infective masses, pyogenic abscesses (n = 6) showed resonances only from cytosolic amino acids, lactate, alanine, and acetate; and tuberculomas (n = 11) showed only lipid resonances [13].
• The choline/creatine ratio was greater than 1 in all tuberculomas but in none of the cysticerci [14].

Biological context of Tuberculoma

• Visual acuity improved 9 weeks after the onset of visual acuity impairment and returned to normal 24 weeks later.Follow-up computed tomographic scan of brain 1 year later demonstrated complete resolution of tuberculomas [15].

Anatomical context of Tuberculoma

• We examined a case of endocardial tuberculoma at the proximal superior vena cava and the right atrium in a 17-year-old male patient [16].
• Disseminated tuberculomas in spinal cord and brain demonstrated by MRI with gadolinium-DTPA [17].
• In this study, we report a series of 22 adult cases of symptomatic central nervous system tuberculomas, in eight of them tuberculomas were coexisting with TBM on admission and in 14 of them symptomatic tuberculomas developed during anti-tuberculosis therapy [2].

Gene context of Tuberculoma

• Only tuberculomas were associated with a midline shift on CT (four of six cases) [18].
• Because of the possibility of late development of tuberculomas after initial successful treatment, all TBM patients need to be followed-up carefully for a long period [2].
• Case report: hypothalamic tuberculoma associated with secondary panhypopituitarism [3].
• There was no statistically significant difference between the outcome of the patients with and without CSF paradoxical response; however, new tuberculomas developed more frequently in the first group (p < 0.05) [19].
• Reported here is an obstruction of the right ventricular outflow tract caused by a tuberculoma in a 15-year-old boy who presented with a ventricular septal defect [20].

Analytical, diagnostic and therapeutic context of Tuberculoma

• Since tubercular lesions form an important differential diagnosis in our country, tuberculoma models in mice have been created and imaged using iodine-125 radiolabelled antimycobacterial monoclonal antibodies for the aetiopathological diagnosis [21].
• In addition to antituberculous chemotherapy and dexamethasone, surgical decompression was needed to treat the expansion of the spinal tuberculoma [22].

References