RT Journal Article
SR Electronic
T1 Tumour-like presentation of brainstem tuberculoma: a lesson learnt
JF BMJ Case Reports
JO BMJ Case Reports
FD BMJ Publishing Group Ltd
SP e251672
DO 10.1136/bcr-2022-251672
VO 15
IS 9
A1 Yeat, Chia Ming
A1 Achmad Sankala, Hairuddin
A1 Mohd Zaki, Faizah
A1 Mohamed Mukari, Shahizon Azura
YR 2022
UL http://casereports.bmj.com/content/15/9/e251672.abstract
AB Brainstem tuberculoma is diagnostically challenging as it lacks clinical clues and imaging mimics a high-grade glioma (HGG). We report the case of an adolescent girl diagnosed with brainstem HGG, who was referred to our centre for Gamma Knife. Initial MRI showed a pontomedullary junction, ring-enhancing lobulated lesion demonstrating distinct central hypointensity on T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) images with extensive vasogenic oedema. An alternative diagnosis of infection was entertained, and biopsy was suggested; however, the parents opted for a trial of alternative treatment. Suboccipital craniotomy and debulking were only performed 3 months later when her symptoms worsened, and MRI revealed enlargement of the lesion. A cheesy ‘tumour’ was noted intraoperatively; histopathological findings later confirmed chronic granulomatous inflammation. In an endemic area, a high index of suspicion of a tuberculoma is vital specifically in the presence of central T2W/FLAIR hypointensity of a ring-enhancing lesion.