Case Of the Week (COW) 07 June 2015
Tubercular abscess brain.
Findings
T1 hypotense conglomerulate lobulated lesions hyperintense on T2 with cystic areas with surrounding edema which does not show diffusion restriction shows few blooming foci on SWI. On contrast shows ring enhancement. MRS shows lipid pea. Biopsy proven to be tuberculoma.
Discussion
CNS TB is a great mimicker of brain tumours, and the index of suspicion should be high, especially in endemic areas. A diagnosis is based on clinical presentation and the results of investigations. In patients with CNS TB that present with a mass lesion, a biopsy should be taken to avoid morbidity and mortality from an unnecessary surgical intervention. Greater use should be made of magnetic resonance spectroscopy in the evaluation of brain space-occupying lesions, and CNS TB should be included in the differential diagnosis of such lesions in all areas endemic for TB.
Contributed By:
Prof. S Babu Peter, Dr. Arun Prasad
Barnard Institute of Radiology
Tubercular abscess brain.
Findings
T1 hypotense conglomerulate lobulated lesions hyperintense on T2 with cystic areas with surrounding edema which does not show diffusion restriction shows few blooming foci on SWI. On contrast shows ring enhancement. MRS shows lipid pea. Biopsy proven to be tuberculoma.
Discussion
CNS TB is a great mimicker of brain tumours, and the index of suspicion should be high, especially in endemic areas. A diagnosis is based on clinical presentation and the results of investigations. In patients with CNS TB that present with a mass lesion, a biopsy should be taken to avoid morbidity and mortality from an unnecessary surgical intervention. Greater use should be made of magnetic resonance spectroscopy in the evaluation of brain space-occupying lesions, and CNS TB should be included in the differential diagnosis of such lesions in all areas endemic for TB.
Contributed By:
Prof. S Babu Peter, Dr. Arun Prasad
Barnard Institute of Radiology