Atypical imaging findings in a case of intracranial tuberculoma

Tuberculosis is a major public health problem in developing nations like India. Tuberculosis of the central nervous system is not uncommon. Meningitis and tuberculoma are the two most important manifestations of tuberculosis of the CNS. Intracranial tuberculomas can present as solitary lesion or multiple lesions. Many atypical radiological findings of tuberculomas are known. They may be indistinguishable from cranial abscess or primary brain tumour. In India, tuberculoma should be considered as a differential in patients with intracranial mass lesions. We present a case of intracranial tuberculoma mimicking a high grade gliomas on magnetic resonance imaging and clinical presentation. A 58-year-old male presented with one-month history of epilepsy. Cranial magnetic resonance imaging showed a in right gangliocapsular region peripheral ring-enhancing lesions with central necrosis and one of the lesion showing thick wall enhancement and highly raised choline/creatinine rat. There was a strong suspicion of glial tumour. On CSF studies of the patient, 100% lymphocytes were noted and no malignant cells were seen. The patient was treated with antituberculous chemotherapy.