En-Plaque Central Nervous System Tuberculoma - An Uncommon Entity: Clinico-Radiological Profile in a Cohort from a Tertiary Referral Centre

摘要

Introduction: Case reports pertaining to Magnetic ResonanceImaging (MRI) diagnosis of en-plaque tuberculoma are limited.To the best of our knowledge, descriptions about en-plaquetuberculoma are limited to few isolated case reports. This papercomprehensively depicts the clinical and radiological featuresin such patients and may serve not to miss this uncommonmanifestation of a common central nervous system infection.Materials and Methods: A descriptive documentation ofthe patient cohort with a detailed history and neurologicalexamination were carried out in all the patients. All underwentMRI Brain which revealed en-plaque tuberculoma. Relevantinvestigations including Cerebrospinal Fluid (CSF) were done inall patients. CSF Polymerase Chain Reaction (PCR) was donein all.Results: Eight adult patients (two women and six men) with MRIshowing en-plaque CNS tuberculoma were seen during a periodof five years. None had suffered from TB in the past nor hadhistory of contact with tuberculosis. All patients demonstratedextra axial dural based lesions and none had cerebral ooedema,parenchymal lesions, mass effect or midline shift. The lesionswere located in bilateral corresponding regions in two patientsand the rest six had unilateral lesions. Seven patients had lesionslocated in the supratentorial compartment; one had lesionextending to the infratentorium along the tentorium cerebelli.Various patterns of enhancement were noted in our patients:thin peripheral (n=3), homogenous (n=3), varied enhancement(n=1) and open ring enhancement (n=1). CSF Polymerase ChainReaction (PCR) was tested positive for tuberculosis in all of ourpatients.Conclusion: While MRI provides an understanding of thetopography of the lesion, PCR helped in establishing thediagnosis of tuberculosis in our patients. Awareness about enplaque tuberculomas can heighten the index of suspicion andcan thus prevent aggressive surgical resections and therebyreduce mortality and morbidity.