Temporal lobe-tuberculoma with blindness as the presenting symptom

Clinical aspects, laboratory findings and imaging results of a patient with a CNS-tuberculoma are presented.

History: The 15-year-old patient from Somalia presented with headaches, psychomotor seizures, and blindness. At age 13 he reportedly had suffered from an unspecified illness with general weakness and progressive loss of vision.

Extended infectiological evaluation showed normal results except for a positive Mantoux-test.

MRI- and CCT-examinations revealed a right temporal 2×1.5cm structure with an extensive perifocal oedema, a circular contrast medium enhancement, and a central calcification zone.

The process was removed in toto.

Histological work-up revealed a fibrotic, encapsulated granuloma with epithelioid and giant cells and a central necrosis, consistent with a tuberculoma.

Discussion: An isolated cerebral tuberculoma without any other evidence of infection is a rare but well known complication of tuberculosis. Blindness is a possible sequela of tuberculous meningitis.

Apparently the patient had suffered from a tuberculous meningitis in Somalia leading to bilateral optic atrophy and tuberculoma, but had recovered otherwise without specific therapy.