Brain stem tuberculosis in children

Tubercular meningitis and intracranial tuberculomas are the two frequent ma nifestations of neurotuberculosis with their variable incidence in differen t countries. Brain stem tuberculomas are even more unusual, accounting for 2.5-8% of all intracranial tuberculomas. We present here six paediatric cas es of brain stem tuberculosis, where well-formed tuberculomas were demonstr ated in five symptomatic cases; however, only a hypodense ill-defined lesio n was found in the brain stem of one child who presented with features of t ubercular meningitis. Three of these children had other associated tubercul omas in their brain parenchyma as well. All the six cases, however, showed the involvement of 3rd, 6th & 7th cranial nerves, in various combinations, at the time of initial presentation. Only two children developed hydrocepha lus and required CSF diversion. All responded well to anti-tubercular chemo therapy, though two children developed toxicity to the therapy, which recov ered with drug manipulation for about 2 months. Recovery was full without r esidual der cit in all the cases. Surgical excision of brain stem granuloma s was not indicated in any case.