Brain tuberculoma in Hong Kong

WY Lee, KY Pang, CK Wong
Department of Neurosurgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong

We report two cases of brain tuberculoma occurring in patients residing in Hong Kong. Both patients presented with headache and had space-occupying lesions evident on computed tomography scans of the brain. The patients had no history of tuberculosis and no symptoms of concurrent extracranial tuberculosis were evident. The diagnosis of tuberculoma was made at the time of surgical excision. Delayed diagnosis of brain tuberculoma is likely to occur in industrialised countries where tuberculosis is rare. In Hong Kong, however, with a constant influx of foreign domestic workers from endemic regions, a high index of suspicion should be maintained. Imaging studies support, but do not confirm, the diagnosis of brain tuberculoma. We recommend obtaining a definitive histological diagnosis, with computed tomography–guided stereotactic biopsy, before starting antituberculous therapy. Surgical excision is necessary in patients with raised intracranial pressure secondary to the lesion, who are not responding to medical therapy.

Hong Kong Med J 2002:8:52-6

Key words: Diagnosis, differential; Hong Kong; Magnetic resonance imaging; Tomography, X-ray computed; Tuberculoma, intracranian