Intracranial tuberculoma: A narrative review of clinical features, diagnosis, and management in resource-constrained settings

Abstract

Background: Intracranial tuberculoma is a rare, non-neoplastic central nervous system condition, typically presenting as a ring-enhancing lesion on imaging. Its clinical manifestations are varied and nonspecific, often mimicking tumours or other infections, making diagnosis challenging. Management primarily involves prolonged anti-tuberculous therapy, supported by interventions based on the location and severity of the lesion.

This paper reports the clinical presentations, diagnostic methods, and management of intracranial tuberculoma, showing key challenges in resource-constrained settings.

Case presentation: Case 1: A 25-year-old man presented with progressive gait instability, left-sided weakness, numbness, strabismus, dysarthria, and facial nerve palsy. Examination revealed a Glasgow Coma Score (GCS) of 15 and mild visual impairment. MRI showed a solitary, ring-enhancing brainstem lesion. Anti-tuberculous therapy (ATT) led to complete symptom resolution, with follow-up imaging at 12 months confirming full radiological recovery.

Case 2: A 36-year-old woman presented with worsening gait, facial asymmetry, visual decline, and altered consciousness. Her GCS was 11, and a positive Mantoux test supported a tuberculous aetiology. CT imaging revealed a ring-enhancing lesion in the left cerebellopontine angle, extending into the brainstem with obstructive hydrocephalus. CSF diversion was performed, and CSF analysis was consistent with tuberculosis. ATT was initiated, with clinical improvement noted. However, the patient was lost to follow-up after four months, despite initial symptom resolution.

Conclusion: Intracranial tuberculomas may present without systemic signs and require high clinical suspicion for diagnosis, particularly in endemic areas. In low-resource settings, barriers such as limited imaging access and socioeconomic factors can hinder diagnosis, adherence to therapy, and follow-up.