Tuberculoma is a non-cancerous mass caused by localized tuberculosis infection, most commonly in the brain and lungs. It presents with nonspecific symptoms like headache, nausea, and fever. Diagnosis involves CT or MRI imaging showing well-defined focal masses, and lab tests of CSF fluid and tissues. Treatment requires a minimum 9 months of anti-tuberculosis medications like isoniazid and rifampicin.

2. Content
 Introduction
 Etiology
 Transmission
 Risk factor
 Sign & symptoms
 Diagnosis - CT, MRI
 Lab diagnosis
 Treatment

3. Introduction
• Tuberculoma or Tuberculous granulomas – Well defined focal
masses that results from mycobacterium tuberculosis
infection.
• One of severe morphological forms of tuberculosis.
• Most commonly occur in the brain and lungs.
• A Tuberculoma is a benign non-neoplastic mass (a tumor-like
mass that is not a cancer) caused by a localized tuberculosis
infection.

4. Etiology
• Mycobacterium tuberculosis
• Immuno compressed person
• By air droplets
• By exposure with person who is infected to
prolonged

5. Transmission
• From person to person through the air
• Someone who’s sick cough, sneezed,
talks, cough or sings, tiny droplets that
contain the germ are released.

6. Risk factor
• 0.55% - 15% of systemic TB cases
• 1% intracranial Tuberculoma are seen
• Intradural spinal tuberculomas – 2-5% of CNS tuberculomas
• Malnutrition
• Alcohol addiction
• Infant and children under 5yrs of age
• Smoking
• HIV

7. Sign &symptoms
• Headache/ vertigo
• Nausea/ Vomiting
• Weight loss
• Anorexia
• Fever
• Chills
• Night sweat
• Feeling tired at all time
• Stiff neck
• Blurry vision
• Confusion
• Spinal cord lesion
• Seizure
• Cranial nerve deficits
• Papilledema
• Meningismus

8. Diagnosis
 CT –scan :- Head
• Use ionizing radiation
• Done with contrast/ without contrast
• Suspicion of intracranial or intramedullary TB
• Immature lesions are hypodense and non-enhancing
• Many time findings are similar as CNS lesions, including fungal
infections, neuro sarcoidosis, metastatic disease

9. CT

10. MRI Scan - Brain
• Use high magnetic field
• More specific and sensitive than CT.
• Done with or without contrast
• T1 weighted- Shows central iso-intensity
• T2 weighted – Shows the pathology
• Also mimic several of the aforementioned lesions.

11. MRI

12. Laboratory Test
 CSF fluid – lumbar puncture – 10-15 ml
• Show normal findings or have elevated protein, decreased
glucose, or proteolysis.
• Always make AFB smear when testing CSF.
 Montoux test :- May be positive or negative
 WBC count:-
• male- 5000-10000/ml
• female - 5000-10000/ml
 RBC count :-
• Male - 4.5-5.5 *106/ml
• female – 4-5 *106/ml
 Platelet count
• Male- 1.4 -4*105/ml
• female– 1.4 -4*105/ml

13. ------
IGRA

14.  IGRA ( Interferon gamma release Assay)
• Measure the immune response to mycobacterium
tuberculosin.
 PCR ( Polymerase chain reaction)
• To detect TB antigen and the LEO-FM microscopy technique to
identify TB antigen with microscopy may be used.
 Biopsy
• Done to see the histo-pathology of tissue.
• May show central necrosis, lymphocytes, Langerhans giant
cells or epitheloid cells.
• No definitive diagnostic pathway is available for CNS TB.

15. Treatment
 Medication – Anti tuberculin drugs
 duration minimum doses
• 9 months 270 mg
• 4 months 120mg
• 3 months 12mg
 First line drug :- Isoniazid, rifampicin
 Second line drug :- caperomycin, amikacin
 Vaccination – BCG ( Bacillus calmette Guerin)
 DOTS ( Direct observed Therapy)