TUBERCULOMA INTRACRANEAL: ETUDIO DE 40 PACIENTES

The clinical and radiologic findings in 40 patients with intracranial tuberculoma were reviewed. The clinical picture was characterized by various combinations of focal signs and symptoms of subacute onset, similar to those produce by other space-occupying lesions of the central nervous system. Twenty-one patients had evidence of systemic tuberculosis, which was most often visualized in an x-ray film of the chest. Twenty-eight patients had isolated intracranial tuberculomas, and the remaining 12 patients had tuberculomas associated with tuberculous meningitis. Intracranial tuberculomas were located in the cerebral hemispheres in 24 patients, in the brain-stem in 12 patients, and in the cerebellum in 4 patients. Computed tomography (CT) (showed hipo-, iso-, or hyperdense lesion with abnormal contrast enhancement. Seven patients were also studied with magnetic resonance imaging, that showed lesions with long T1 and short T2 relaxation times. These were nonspecific findings that may be observed in other type of intracranial mass lesion. Cerebrospinal fluid analysis also showed nonspecific findings, as smears for acid-fast bacilli were most often negative. A correct diagnosis of tuberculoma was done in 28 patients. Prompt therapy with antituberculous drugs resulted in clinical and CT improvement in 19 of these 28 patients. In contrast, the prognosis of the 12 patients, in whom the diagnosis was not suspected was poor: 7 patients died, and 3 survived with major neurologic sequelae. Intracranial tuberculomas should be suspected in patients with space-occupying lesions fo the central nervous system who live in geographic areas where tuberculosis is endemic. Early diagnosis and prompt medical therapy are important in preventing mortality and reducing morbidity.