Intracranial tuberculomata-an unusual presentation

Posted by Dr.Chakravarthi Dr.Chakravarthi
24 years female presented with complaints of sudden onset of inability to use her right arm & difficulty moving her right lower limb one night. She also felt a kind of heaviness of right upper and lower limbs, which continued for around 20-30 minutes. The next morning she found the same kind of sensation of heaviness of right upper and lower limbs. She also complained of headache since 3 days, which was global, dull aching, and continuous.
In the past, she has had one abortion at 4 months of gestation an year ago.
Clinical Examination:
She had mild right supra nuclear facial paresis.
Other cranial nerves & sensory-motor system were within normal limits.
Deep tendon reflexes were normal.
Gait was normal.
Possibilities of TIAs (transient ischemic attacks), vascular migraine, and seizures were thought of.
Investigations revealed elevated ESR (35mm/hr).

She was initially treated with steroids and antiepileptics.
She developed fever with positive kernig’s sign and worsening headache.
She also developed 3 episodes of generalized seizures.
A lumbar puncture and CSF analysis revealed lymphocytosis (130 lymphocytes) with normal sugar and protein. The CSF antibody  was positive for tuberculosis and negative for cysticercosis.
She responded to ATT and steroids.
Presently, she is afebrile, seizure free with no further progression in her neurology.