MRI Intracranial tuberculoma

Intracranial tuberculoma is a form of tuberculosis that affects the brain. It involves the formation of one or more mass-like lesions or tubercles within the cranial cavity. These lesions result from the infection caused by the bacterium Mycobacterium tuberculosis. Intracranial tuberculomas are part of a broader category of tuberculosis infections that can affect various parts of the body outside the lungs, known as extrapulmonary tuberculosis.

Causes

The primary cause of intracranial tuberculoma is the spread of Mycobacterium tuberculosis bacteria from another infected site in the body, typically the lungs, to the brain. This spread usually occurs through the bloodstream. Factors that may increase the risk include weakened immune systems, such as in individuals with HIV/AIDS, diabetes, or those taking immunosuppressive medications.

Symptoms

The symptoms of intracranial tuberculoma can vary depending on the location and size of the lesions. Common symptoms include:

• Headaches
• Seizures
• Neurological deficits (such as weakness or sensory losses in certain parts of the body)
• Behavioral changes or confusion
• Nausea and vomiting
• Fever and night sweats (general signs of infection)

Diagnosis

Diagnosing intracranial tuberculoma involves a combination of clinical evaluation, imaging studies, and laboratory tests:

• Imaging Studies: Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans are commonly used to detect lesions in the brain. These imaging modalities can help differentiate tuberculomas from other types of brain tumors or lesions.
• Laboratory Tests: Tests such as cerebrospinal fluid (CSF) analysis, which may include PCR for tuberculosis, cultures, and sensitivity tests. Blood tests can also detect markers of infection and inflammation.
• Biopsy: In some cases, a biopsy of the lesion may be performed to confirm the diagnosis by directly observing the tuberculosis bacteria.

Treatment

The treatment of intracranial tuberculoma generally involves a long-term course of antibiotics to eradicate the tuberculosis infection. The typical regimen includes:

• Antituberculous Therapy (ATT): A combination of drugs such as isoniazid, rifampicin, ethambutol, and pyrazinamide, taken for a minimum of 6-12 months.
• Corticosteroids: May be used to reduce inflammation and edema around the lesions, particularly if they are causing significant pressure or symptoms.
• Surgery: Although less common, surgical intervention might be required if there is a need to relieve intracranial pressure, if the lesions are large or if the response to medical treatment is inadequate.