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  • Title: Prognostic indicators in patients with intracranial tuberculoma: a review of 102 cases.
    Author: Wasay M, Moolani MK, Zaheer J, Kheleani BA, Smego RA, Sarwari RA.
    Journal: J Pak Med Assoc; 2004 Feb; 54(2):83-7. PubMed ID: 15134209.
    Abstract:
    OBJECTIVE: To see the characteristics, course and outcome of patients suffering from intracranial tuberculoma. METHODS: Retrospective review of 102 patients diagnosed as intracranial tuberculoma at a tertiary care center over 10 years. RESULTS: A total of 102 cases were seen with an age range of 1 to 75 years (mean, 30 years). Predisposing factors included Diabetes mellitus (8 patients) and pregnancy or puerperium (7 patients). Five pediatric patients had tuberculoma despite documented BCG vaccination. Fever (59%), headache (57%), meningeal irritation (36%) were the commonest presenting features; one-third of patients were drowsy or comatosed at presentation. Cerebrospinal fluid analysis was performed in 63 patients, of whom 88% had elevated protein, 83% had low glucose, and 84% had pleocytosis (one-third with neutrophilia). Forty-nine (50%) patients had clinical or laboratory evidence of concomitant tuberculous meningitis. Chest radiographs showed active or old tuberculous infection (25%), with a miliary pattern in 20%. Two-thirds of subjects had multiple tuberculomas (mean, 4.5 lesions per patient) on contrast CT or MRI scan. Hydrocephalus was present in 37 (37%) patients of which 21 required shunt surgery. Thirty-nine patients had > 9 months of follow up; 17 patients showed complete recovery, 20 patients had partial recovery, and 2 patients had no response. Coma at presentation and miliary pattern on chest X-ray were predictors of poor prognosis. CONCLUSION: The study demonstrate that fever, headache, signs of meningeal irritation and cranial nerve palsies are common presenting features. Complete recovery was seen in 40% patients. Coma and military TB are predictors of poor prognosis.
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