Abstract Details

Title Solitary Tuberculous Brain Lesions: 24 New Cases and a Review of the Literature

Topic Infections/AIDS/Prion Disease

Presentation(s) P04 - (-)

Poster/Presentation
Number 012

Objective

Background BACKGROUND: A solitary tuberculous brain lesion (STBL) can be difficult to distinguish from glioma, metastasis or brain abscess. Accurate, early diagnosis is important for appropriate management and prognosis.

Design/Methods DESIGN/METHODS: We analysed the clinical characteristics, diagnostic procedures and outcomes of 24 consecutive patients with STBL diagnosed in France, India and Mexico. We also reviewed 92 STBL cases previously reported in the literature.

Results RESULTS: Non-neurological signs were found in 54% of our patients (28% in the literature), including adenopathy in 20% of cases. Cerebrospinal fluid (CSF) was typically abnormal, with lymphocytic pleocytosis and a high protein level. Lung CT scan was abnormal in 56% of patients, showing lymphadenopathy or pachypleuritis. Brain MRI or CT was always abnormal, showing contrast-enhancing lesions. Typically, MRI abnormalities were hypointense on T1-weighted sequences, while T2-weighted sequences showed peripheral hyperintensity with central hypointensity. The diagnosis was documented microbiologically or supported histologically in 71% of cases. The response to antituberculous therapy confirmed the diagnosis in the remaining cases. Clinical outcome was good in 83% of cases.

Conclusions CONCLUSIONS: STBL should always be considered in patients with a contrast-enhancing, intracranial space-occupying lesion. CSF examination, lung CT and conventional brain MRI can provide helpful clues. The diagnostic strategy should be individually tailored, taking into account the likely benefits and risks of brain biopsy versus presumptive antituberculous treatment.

Authors/Disclosures
PRESENTER	No disclosure on file
Dimitri Psimaras, MD (Hopital Salpetrière ; Service)	No disclosure on file
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Frederik Barkhof, MD, PhD (Image Analysis Center)	Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Frederik Barkhof has received personal compensation in the range of $0-$499 for serving as a Consultant for Biogen. Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Combinostics. Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving as a Consultant for IXICO. Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Frederik Barkhof has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EISAI.
Tag-Eldin Sokrab, MD, PhD, FAAN (Hamad Medical Corporation)	Dr. Sokrab has nothing to disclose.
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