Calvarial Tuberculosis Mimicking Meningioma: An Unusual Cause for Aphasia with Scalp Swelling
12 November 2015
18 December 2015
08 June 2016 (eFirst)
Background Calvarial tuberculosis is uncommon. It usually presents as a punched out lesion with varying extend of extradural and subgaleal collection. However, typical imaging findings may be lacking and may appear as a neoplasm-like meningioma. This report details the clinical and imaging findings of a left frontal lesion which mimicked neoplasm.
Clinical Presentation A 54-year-old female patient presented with decreased speech output and a gradually growing swelling on the left side of the scalp for 1 year duration. On imaging, lesion was left frontal subgaleal plane and left frontal parenchyma with different signal changes. Bony changes were minimal. Our preoperative diagnosis was a central nervous system tumor-like convexity meningioma with an extracranial growth or a dural-based sarcoma or slow-growing metastasis. The patient underwent left frontal craniotomy and excision of the lesion. Histopathology was suggestive of tuberculous granuloma.
Conclusion Our report represented a case of diffuse variety of calvarial tuberculosis with significant growth into brain parenchyma which is rare. It should be kept as one of the differential diagnosis of lesions with intracranial and scalp component. Awareness will help in managing and prognosticating these lesions.
- 1 Boutarbouch M, Arkha Y, Gana R, El Maquili MR, Bellakhdar F. Tuberculoma of the cavernous sinus mimicking a meningioma: case report and review of the literature. J Neurol Sci 2009; 278 (1–2) 123-126
- 2 Sonmez G, Ozturk E, Sildiroglu HO , et al. MRI findings of intracranial tuberculomas. Clin Imaging 2008; 32 (2) 88-92
- 3 Gupta RK, Kumar S. Central nervous system tuberculosis. Neuroimaging Clin N Am 2011; 21 (4) 795-814 , vii–viii
- 4 DeLance AR, Safaee M, Oh MC , et al. Tuberculoma of the central nervous system. J Clin Neurosci 2013; 20 (10) 1333-1341
- 5 García-García C, Ibarra V, Azcona-Gutiérrez JM, Oteo JA. Calvarial tuberculosis with parenchymal involvement. Travel Med Infect Dis 2013; 11 (5) 329-331
- 6 Mukherjee KK, Kaushik R, Nada R, Khosla VK, Khandelwal N, Kak VK. Calvarial tuberculosis. Surg Neurol 2002; 57 (3) 195-202 , discussion 202–203
- 7 Tyagi AK, Kirollos RW, Kang NV. Tuberculous osteitis of the skull: a case report and review of the literature. Br J Neurosurg 1996; 10 (4) 399-401
- 8 Ramdurg SR, Gupta DK, Suri A, Sharma BS, Mahapatra AK. Calvarial tuberculosis: Uncommon manifestation of common disease—a series of 21 cases. Br J Neurosurg 2010; 24 (5) 572-577
- 9 Saini J, Gupta RK, Jain KK. Intracranial infections: key neuroimaging findings. Semin Roentgenol 2014; 49 (1) 86-98
- 10 Patkar D, Narang J, Yanamandala R, Lawande M, Shah GV. Central nervous system tuberculosis: pathophysiology and imaging findings. Neuroimaging Clin N Am 2012; 22 (4) 677-705