Tuberculoma Brain: Diagnostic Criteria and Conservative Management

Abstract

Background: There is  evidence  that  medically treated Tuberculoma patients have  a significantly  better functional  recovery than those having surgical excision. This would not be possible theoretically unless strict diagnostic criteria are applied and  if there is still doubt, resort to surgical excision or biopsy so that patient’ health is not  jeopardized . 

Objectives : To  evaluate  the   Effectiveness of  Conservative  management of  Tuberculoma of Brain based on strict   Diagnostic Criteria.

Study Design: Prospective Study

Place and Duration of Study: This study was conducted at Assir  Central  Hospital  Abha  KSA from  March 2001 to August 2003.

Materials and Methods: Out  of  total  thirteen patients, Eight Patients presented with signs of raised intracranial tension  ( Headache, Vomiting ),  Two   with localizing symptoms or signs (Hemiparesis   and  Diplopia), Two with  history  of  Fever, Night sweats, Cough, and  had  been receiving immunosuppressive agents.  One   pregnant  patient presented with history of convulsions  on term. Three   patients had Solitary and Ten patients Multiple Lesions. Maximum number of Lesions in our cases were  Eleven and minimum was one.

Results: Patients  were diagnosed  based on Strict  Criteria like  Blood Smears, ESR ,  CRP ,  Acid-fast   Bacillus  in Sputum   smears, CSF serology X-ray  Chest, Contrast- enhanced  CT and MRI.

Failure of medical treatment occurred in two patient. One pregnant patient was operated   due to intractable Epilepsy following caesarian section on term. The patients were followed for six  months  to  Two  years  without recurrence.

Conclusion: Diagnostic Criteria helped us to filter out TB Positive cases as against Bacterial, fungal and  Actinomycotic  infections of brain. Conservative management alone was successful in the Treatment of Tuberculoma of Brain.