Bilateral ptosis: An unusual presentation of mid brain tuberculoma

Case report: Depressive disorder with peripartum onset camouflages suspected intracranial tuberculoma

BACKGROUND

Co-occuring psychological symptoms and rare medical illnesses like intracranial tuberculoma add difficulties in diagnosing and treatment. The present report discussed a rare case of a young woman with tuberculoma and depressive disorder with peripartum onset.

CASE PRESENTATION

The patient was a 22-year-old woman. She underwent a cesarean section due to premature rupture of the membrane. She had developed behavioral changes for 3 months before admission and had been brought to general practitioner for several times during pregnancy. Her symptoms worsen after she underwent a cesarean section. She refused to answer doctor's and family's questions and she showed symptoms of depression. She was diagnosed with depressive disorder with peripartum onset and treated according to her diagnosis. However, she also experienced intermittent headaches which lead to suspicion that there was an organic cause for her complaints. Computed tomography (CT) was done and revealed suspected intracranial tuberculoma and meningitis. She died due to respiratory distress before she got adequate treatment for her illnesses.

CONCLUSION

The possibility of neurocognitive disorder due to infection such as intracranial tuberculoma should be considered as an additional diagnosis (co-occuring disease) or differential diagnosis in people who develop psychiatric symptoms, especially in areas with high tuberculosis incidence.

Intracranial tuberculomas: A case report of clinical, radiological, and pathological characteristics

Background

Intracranial tuberculomas are uncommon yet devastating forms of extrapulmonary tuberculosis with a high mortality rate and morbidity risk. A high level of suspicion is required for a prompt diagnosis and treatment.

Case description

A 67-year-old male, medically free, presented at the Emergency Department with a 1-day history of nausea and vomiting, and a 15-day history of imbalance and dizziness. Radiological imaging demonstrated right well-defined ring-enhancing lesions. He underwent a sup-occipital craniotomy with lesion resection. The diagnosis of an intracranial tuberculoma was confirmed histopathologically. Anti-tuberculosis therapy was prescribed, and the patient was discharged with mild cerebellar dysfunction.

Discussion

Intracranial tuberculomas have a high rate of mortality and morbidity. It is critical to consider tuberculoma in the differential diagnosis of intracranial lesions with such clinico-radiological characteristics, especially in developing countries.

Conclusion

In this article, we are reporting an interesting case with multiple intracranial tuberculomas with an extensive review of the literature.

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Fever and leukocytosis can be absent upon the initial presentation of intracranial tuberculomas.

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Immunocompetent patients can present with intracranial tuberculoma as the initial presentation of tuberculosis.

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Intracranial tuberculoma can present as single/multiple lesion/s with radiological appearance similar to intracranial neoplasms.

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The indistinct radiological findings of intracranial tuberculoma can be due to the different stages of maturation.