Tuberculosis is a major health problem in developing countries; tuberculoma involving the central nervous system is still uncommon as compared to involvement of other systems . The incidence is variably quoted between 2.3% to 18%.Intracranial tuberculomas are rare, usually involve cerebral and cerebellum due to rich blood supply and only 4% are located in
brainstem . CNS tuberculoma usually confused with intracranial neoplasm whenever presented without signs and symptoms of tuberculosis. Depending on their size and location, intracranial tuberculomas can have many signs mimicking primary central nervous system tumour such as high intracranial pressure, focal neurological deficits, and seizures . Our patient presented with rare clinical presentation in the form of horizontal gaze evoked nystagmus. Mainly three mechanisms are involved to maintain foveal centration of an object of interest; fixation, vestibulo-ocular reflex, and the neural integrator. A disorder affecting any three of this position in the orbit, the fascia and ligaments that suspends the eyes exert an elastic force to return to primary position. Brain MRI revealed multiple small rim andnodular enhancing lesions with mild perilesional edema in both cerebral and cerebellar hemisphere and pons. Chest X-ray, USG abdomen was normal. Patientâs ESR was 70, Hb 10.8 gm%, TLC 8300/dl. Mountoux test shows 14 mm induration after 72 hours. CSF analysis was normal.
Sunil K Gothwal, Multiple Tuberculoma in Brain Presented with Isolated Ocular Abnormality: A Case Report
Last date updated on July, 2014