Tubercular Lesions in Brain Parenchyma

Background: Preoperative neuro-radiological features of tuberculosis involving brain lesions may mimic neoplastic lesions of brain & skull base and post operative histopathological study or response to empirical anti-tubercular therapy brings the ultimate diagnosis. Objective: Here we present our experience of 76 cases of cerebral and cerebellar tuberculosis that was managed surgically with anti-tubercular drugs or medical treatment alone without histopathological confirmation. Methodology: All cases of brain parenchymal tuberculosis confirmed histopathologically after surgery or confirmed by succesfull conservative treatment with anti-TB from January 2008 to June 2015 were included for study. Tubercular meningitis was excluded from the study. Patients underwent some form of surgery that confirmed the tuberculosis by histopathologically. Patients with suspected tubercular lesion in brain were treated empirically with antiTB. Post operative imaging was done with CT scan of brain or MRI of brain in immediate post operative period, six months after operation and 18 months after operation. Results: 34 patients underwent surgery to confirm the tuberculosis and 44 patients with suspected tubercular lesion in brain were treated empirically with antiTB of which 40 patients responded successfully and rest 4 patients did not responded and underwent surgical excisional biopsy. Common clinical features include features of raised ICP with focal signs and symptoms. Concurrent other systemic tuberculosis was found in three cases. One patient had history of full course anti-tubercular therapy for pulmonary tuberculosis 20 years back. Conclusion: In suspected TB lesions, conservative treatment without histopathological diagnosis may be adopted with ultimate same result Bangladesh Journal of Infectious Diseases, December 2018;5(2):45-60