Article ID: JJID.2015.104
Brain tuberculomas can exhibit many different clinical and radiological patterns. However, disseminated or military brain tuberculomas are very rare. Miliary brain tuberculomas have specific clinical prognostic implications. Seven patients diagnosed with miliary brain tuberculomas between December 2004 and August 2012 were evaluated retrospectively. Their clinical features, cranial magnetic resonance imaging (MRI) characteristics, treatments, and outcomes were reviewed.The median patient age was 42 years (range, 22–66 years). Six patients presented with a fever, five with headache, four with papilledema, and three with diplopia. MRI studies revealed multiple brain lesions. There were 20-50 lesions at the same level on MRI. These lesions measured approximately 2-4 mm in diameter and exhibited ring or nodular enhancement after gadolinium injection. All patients began to recover within 2 weeks after beginning antitubercular therapy (ATT). The number of lesions on MRI decreased by half within 1 month, and all had healed with no any sequelae after 18 months of regular ATT. Miliary brain tuberculomas are rare forms of central nervous system tuberculosis. Some special characteristics of miliary brain tuberculomas are as follows. First, mild atypical clinical manifestations are present, and laboratory findings are close to normal. Second, the radiological features are severe, and 20-50 lesions are present at the same level on MRI. Third, they exhibit a good response to standard ATT. Finally, they are benign; no patients died in our study. Early recognition and treatment can result in full recovery.
