Cerebral Tuberculoma

A cerebral tuberculoma is an intracranial tuberculous granuloma, a focal lesion of the brain parenchyma or meninges, mostly formed by hematogenous spread from other sites; a minority results from residual infection after diffuse tuberculous meningitis. Incidence is 1.4%. It can occur anywhere intracranially, more often infratentorial than supratentorial, mainly in children and adolescents. With improved living standards and anti-TB drugs, incidence has been declining.

Common Symptoms

Lymphadenopathy; ataxia; focal symptoms; night sweats; fatigue

Causes and Pathogenesis

(1) Etiology: Cerebral tuberculomas are usually secondary to TB elsewhere, especially pulmonary TB. (2) Pathogenesis: After hematogenous dissemination of primary TB ceases, many bacilli persist in the CNS; once cell-mediated immunity changes, they form small nodules that do not rupture into the subarachnoid space (so no meningitis) but develop within the parenchyma as well-circumscribed tuberculomas with dense fibrous capsules, usually under 1 cm in diameter, yellow-white or gray-yellow, with central caseous necrosis or granulation; strong host defenses may completely calcify them, and rare central liquefaction forms simple abscesses. Meningeal tubercles may enlarge into flat tuberculomas. Lesions are often solitary, occurring anywhere intracranially; infratentorial lesions are mainly in the cerebellar hemispheres (common in children), while supratentorial lesions prefer the frontal and parietal lobes. They may also occur in the brainstem, corpus callosum, pineal, ventricles, basal cisterns (sellar region, cerebellopontine angle), and meninges. Multiple lesions may cluster in one lobe or in both hemispheres. Perilesional meningeal adhesions are common (up to 80% in the posterior fossa). Tuberculomas are often superficial but may be deep, with a hard capsule, clear borders, surrounding edema, and poor blood supply.

Treatment

Drug therapy, supportive therapy

Preventive Measures

Cerebral tuberculoma is an intracranial granuloma secondary to systemic TB. Prevention focuses on avoiding exposure, vaccination after birth, and early treatment. Patients with anemia, night sweats, weight loss, fatigue, or low fever should seek prompt diagnosis and self-isolate. If intracranial hypertension or brain damage occurs, see a specialist; CT or MRI confirms diagnosis. Systemic cases are treated with anti-TB drugs; localized cases are treated surgically with good prognosis.

Department to Visit

It is recommended to visit the Infectious Diseases department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.