TUBERCULOMAS PRESENTING AS ISOLATED INTRINSIC BRAIN-STEM MASSES

We document the clinical presentation, management and outcome of histo logically verified, solitary, intrinsic brain stem tuberculomas in six patients. The neurological symptoms and signs in these patients did n ot distinguish their lesions from other intrinsic masses of the brain stem. On contrast-enhanced computed tomography (CT), the tuberculomas appeared as ring enhancing lesions in three patients and nodular contr ast enhancing lesions in the other three. Diagnosis was established on the basis of CT-guided stereotactic biopsy in all patients. All patie nts were treated with antituberculous drugs for 18 months. Steroid the rapy of 2-8 weeks duration was also used in four patients. At a median follow-up period of 20 months (range 9-51 months), three patients wer e asymptomatic and the other three were functioning independently with mild disability. Although isolated, intrinsic brain stem tuberculoma is an uncommon entity, it should be suspected in patients presenting w ith features of an intrinsic brain stem mass and a contrast-enhancing lesion on CT. CT-guided stereotactic biopsy usually provides evidence of the inflammatory nature of the mass although an aetiological diagno sis is often elusive. Early diagnosis and appropriate therapy with ant ituberculous drugs and steroids usually results in an excellent or goo d outcome in most instances.