Open Access

Clinical Presentation Of CNS Tuberculoma

The clinical presentation of CNS tuberculoma is usually more subtle than that of TB meningitis and may include headache, seizures, focal neurologic deficits, and papilledema. Tuberculomas accompany TB meningitis in 10% of patients and are multiple in a third of patients. Lesions may occur in the brain, spinal cord, subarachnoid, subdural, or epidural space; they may be solitary but are most often multiple and accompanied by surrounding edema and ring enhancement. In children, lesions tend to be infratentorial, whereas in adults they are typically supratentorial. On CT, tuberculomas are characterised as low- or high-density and rounded or lobulated masses and show intense homogenous or ring enhancement after contrast administration. They have an irregular wall of varying thickness. Moderate to marked perilesionaloedema is frequently present. Tuberculomas may be single or multiple and are more common in frontal and parietal lobes, usually in parasagittal areas. On CT, the target signâ, a central calcification or nidus surrounded by a ring that enhances after contrast administration, is considered pathognomonic of tuberculoma.