Intracranial tuberculomas: The Hofuf, Saudi Arabia experience

Abstract

Tuberculosis usually involves the brain through haematogenous spread. The mass lesion caused by tuberculosis in the brain is called tuberculoma, which is a conglomerate of tubercles. Tuberculomas may also be found in the spinal cord. Because of their slow growth they often become calcified. The study was conducted at the King Fahad Hospital, Hofuf, A1 Hassia, Saudi Arabia between 1992 and 1998. It was a prospective study of all patients which had intracranial mass lesions which showed typical ring-enhancement on brain CT scan with contrast. Twenty patients satisfied inclusion into the study. Of the 20 patients studied. 19 (95%) were males and 1 (5%) was a female. The ages ranged between 22 and 50 years. Eighteen (90%) of the patients were immigrant labourers from Asia and 2 (10%) were Saudi nationals, a male aged 50 years and a female aged 22 years. Fifteen (83.5%) were from India. 2 (11.1%) from Bangladesh, and 1 (5.6%) from Sri Lanka. The presenting feature in 60% of cases was focal seizure with secondary generalisation. 20% had primary generalized seizures, and 30% presented with headache. 25% with weakness of the limbs, 15% with fever and 10% each with vomitting and blurred vision, respectively. In 65% of cases, there was noneurological deficit but 35% had pyramidal weakness in the limbs. In 55% of cases the Tuberculomas were located in the left cerebral hemisphere, 30% in the right cerebral hemisphere and in 15%, the lesions were in both hemispheres. When a male Asian immigrant labourer aged between 20 and 40 years presents with seizures with or without headache, he should have a brain CT scan with contrast to exclude intracranial Tuberculoma. A short course of anti-tuberculous therapy may be tried where there is doubt, irrespective of normal erythrocyte sedimentation rate (ESR) We suggest that when the presenting symptom is primary generalized tonic clonic seizure. the intracranial Tuberculoma is located in the frontal lobe: a high erythrocyte sedimentation rate (ESR) may indicate multiple Tuberculomas.