Intracranial Tuberculoma

7/30/2003 (Bala)

Question: What is the incidence of paradoxical progression or new discovery of tuberculoma in patients on compliant therapy for TB, and how is this treated?

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Unique Identifier:11006617

Authors: Gamage R. Seneviratne U. Constantine GR.

Institution: Institute of Neurology, National Hospital of Sri Lanka, Colombo.

Title: Paradoxical progression of intracranial tuberculous lesions during treatment.

Source: Ceylon Medical Journal. 45(1):31, 2000 Mar.

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Unique Identifier:10450356

Authors: Andrade Filho Ade S. Gomes AG. De Lemos AC. Neves MC. Souza YM. Pereira SL. De Souza AP. Dos Santos PL.

Institution: Hospital Otavio Mangabeira/Secretaria da Saude do Estado da Bahia, Departamento de Neuropsiquiatria (DNP) da Faculdade de Medicina (FAMED) da Universidade Federal da Bahia (UFBA), Brasil. fundacao.neurologia.neurocirurgia@svn.com.br

Title: [Paradoxical expansive lesions of cerebral tuberculosis during antitubercular drug therapy]. [Portuguese]

Original Title: Expansao paradoxal de lesoes de tuberculose cerebral durante o uso de tuberculostaticos.

Source: Arquivos de Neuro-Psiquiatria. 57(2B):471-5, 1999 Jun.

Abstract: Central nervous system involvement by tuberculosis presents two main types: tuberculosis meningitis or tuberculoma. This second condition has nowadays ideal conditions for development. We report three patients who developed paradoxical brain tuberculosis expansive lesion during the use of tuberculostatic drugs. The cases point out the importance of tomography follow up of patients who present neurological signs in the course of treatment for tuberculosis. The first two patients presented onset of the a neurological symptoms, associated with lung tuberculosis. The third patient previously had tuberculous meningitis. Computerized tomography was used to follow up these patients. Tuberculostatic and corticoid drugs were used for treatment. CAS Registry/EC Number 0 (Antitubercular Agents).

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Unique Identifier:9507865

Authors: Bonacina R. Vercesi A. Catania G. Privitera O.

Institution: Department of Urology, St. Corona Hospital, Milano, Italy.

Title: A rare case of cerebral tuberculomas associated with genital tuberculosis.

Source: Journal of Urology. 159(4):1304-5, 1998 Apr.

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Unique Identifier:9279735

Authors: Reiser M. Fatkenheuer G. Diehl V.

Institution: Medizinische Klinik I, University of Cologne, Germany.

Title: Paradoxical expansion of intracranial tuberculomas during chemotherapy.

Source: Journal of Infection. 35(1):88-90, 1997 Jul.

Abstract: A patient from India with military lung tuberculosis who developed intracranial tuberculomas under treatment with tuberculostatics is described. Computed tomography (CT) scans of the brain showed a progress of tuberculomas despite effective tuberculostatic therapy and adjunctive corticosteroid treatment. This phenomenon, termed 'paradoxical response' has rarely been reported. Continuation of chemotherapy led to improvement of brain lesions and a recovery of miliary tuberculosis. When intracranial tuberculomas develop, therapy should be continued for longer than is customary for uncomplicated tuberculosis infections. The use of steroids to suppress a 'paradoxical response' is not proven. CAS Registry/EC Number 0 (Anti-Inflammatory Agents, Steroidal). 0 (Antitubercular Agents).

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Unique Identifier:7616286

Authors: Rao GP. Nadh BR. Hemaratnan A. Srinivas TV. Reddy PK.

Institution: Department of Neurosurgery, Osmania Medical College, Hyderabad, Andhra Pradesh, India.

Title: Paradoxical progression of tuberculous lesions during chemotherapy of central nervous system tuberculosis. Report of four cases. [Review] [17 refs]

Source: Journal of Neurosurgery. 83(2):359-62, 1995 Aug.

Abstract: The peculiar phenomenon of paradoxical progression during the treatment of central nervous system tuberculosis is discussed. A few cases with this phenomenon were reported in the past, and the authors have treated four such cases. During the treatment for tuberculous meningitis, the four patients developed new lesions, mainly in the form of tuberculomas, which progressed for some time and later regressed. In all these cases the initial drug regimen was not changed, except for the addition of steroids for a short period at the time of deterioration. All four patients underwent ventriculoperitoneal shunt insertion during the course of treatment. The authors discuss the significance of the changes in the lesions and management of such cases, and review the literature. [References: 17] CAS Registry/EC Number 0 (Antitubercular Agents). 50-02-2 (Dexamethasone).

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Unique Identifier:7888539

Authors: Afghani B. Lieberman JM.

Institution: Memorial Miller Children's Hospital, Long Beach, California.

Title: Paradoxical enlargement or development of intracranial tuberculomas during therapy: case report and review. [Review] [60 refs]

Source: Clinical Infectious Diseases. 19(6):1092-9, 1994 Dec.

Abstract: Intracranial tuberculomas can sometimes develop or increase in size despite administration of appropriate therapy. We report the case of a child whose intracranial tuberculomas paradoxically enlarged while therapy was being administered, and we review 23 other cases in which tuberculomas increased in size or number and 17 cases in which tuberculomas appeared during therapy. These phenomena generally occurred within 3 months of the start of therapy. All but four patients had neurological deterioration that prompted obtaining a repeated computed tomographic scan. One patient died, about one-fourth of patients had residual neurological symptoms, and less than one-third of the patients required surgical intervention. Most patients received a 12-18 month course of antituberculous therapy. Adjunctive therapy with steroids appears to diminish neurological symptoms and may improve outcome. Paradoxical enlargement or development of tuberculomas usually does not represent failure of antituberculous therapy; the most likely explanation for these phenomena is an interaction between the host's immune response and the direct effects of mycobacterial products. [References: 60] CAS Registry/EC Number 0 (Antitubercular Agents). 0 (Glucocorticoids).

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Unique Identifier:7965125

Authors: Gropper MR. Schulder M. Duran HL. Wolansky L.

Institution: Section of Neurological Surgery and Neuroradiology, University of Medicine and Dentistry, New Jersey Medical School, Newark.

Title: Cerebral tuberculosis with expansion into brainstem tuberculoma. Report of two cases.

Source: Journal of Neurosurgery. 81(6):927-31, 1994 Dec.

Abstract: There are only scattered case reports of intracranial tuberculosis in industrialized nations; brainstem tuberculoma is even more unusual, accounting for 2.5% to 8% of all intracranial tuberculoma. In developing nations, however, central nervous system tuberculosis (CNS-TB) is not rare and intracranial tuberculoma may account for 5% to 30% of all intracranial masses. The authors present two cases of CNS-TB with expansion to brainstem tuberculoma in patients who were undergoing treatment and had no known prior exposure to Mycobacterium tuberculosis.

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Unique Identifier:7695703

Authors: Silman JB. Peters JI. Levine SM. Jenkinson SG.

Institution: University of Texas Health Science Center at San Antonio.

Title: Development of intracranial tuberculomas while receiving therapy for pulmonary tuberculosis [corrected][erratum appears in Am J Respir Crit Care Med 1995 Mar;151(3 Pt 1):927].

Source: American Journal of Respiratory & Critical Care Medicine. 150(5 Pt 1):1439-40, 1994 Nov.

Abstract: Development of tuberculomas on adequate tuberculosis therapy is an uncommon event. This case report describes a patient who developed multiple intracranial tuberculomas while receiving adequate supervised outpatient therapy for sensitive pulmonary tuberculosis who was documented to have no intracranial lesions prior to initiation of treatment. CAS Registry/EC Number 0 (Antitubercular Agents).

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Unique Identifier:1437941

Authors: Provencio Pulla M. de la Fuente J. Hernaez JM. Roman F. Martinez Lopez de Letona J.

Title: Intracranial tuberculoma: paradoxical expansion during medical treatment.

Source: Postgraduate Medical Journal. 68(800):487-8, 1992 Jun.

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Unique Identifier:1628445

Authors: Nozaki H. Takashima S. Ishihara T. Aoyagi T.

Institution: Department of Internal Medicine, National Higashisaitama Hospital.

Title: Paradoxical expansion of intracranial tuberculomas during chemotherapy. [Review] [10 refs] [Japanese]

Source: Rinsho Shinkeigaku - Clinical Neurology. 32(1):91-3, 1992 Jan.

Abstract: A 45-year-old female patient was admitted to a hospital because of tuberculous meningitis in July, 1986. She was treated with chemotherapy (oral isoniazid, rifampicin, ethambutol and an intramuscular injection of streptomycin). Her consciousness was worsened at first, but later she improved aside from some disabilities (incontinence, gait disturbance, disorientation and dementia). She was transferred to National Higashisaitama Hospital in November, 1986. Since then we have continued the chemotherapy, and she has improved gradually. Initially her cranial computerized tomography (CT) revealed no intracranial tuberculoma and showed mild enhancement of basal cistern. About 4 months later, her CT showed many tuberculomas with ringed or nodular enhancement. About 13 months later almost all tuberculomas disappeared. But a few were found with homogeneous enhancement and were enlarged in spite of adequate chemotherapy. These tuberculomas were enlarged while the chemotherapy was continued, but later they were reduced in size. About 3 and a half years later, these tuberculomas disappeared without any calcifications. The above facts may suggest that intracranial tuberculoma could appear and be enlarged on cranial CT in spite of adequate chemotherapy during a course of tuberculous meningitis. They also suggest that continuation of adequate chemotherapy might improve tuberculomas. [References: 10] CAS Registry/EC Number 0 (Antitubercular Agents).

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Unique Identifier:1758007

Authors: AbdulJabbar M.

Institution: Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.

Title: Paradoxical response to chemotherapy for intracranial tuberculoma: two case reports from Saudi Arabia.

Source: Journal of Tropical Medicine & Hygiene. 94(6):374-6, 1991 Dec.

Abstract: Two patients with tuberculous meningitis are described, who developed intracranial tuberculoma while receiving antituberculous therapy. The tuberculoma responded to the same regimen of treatment and small dose of corticosteroids. Such paradoxical reaction should be looked for if the patient develops new neurological signs during the course of the disease. CAS Registry/EC Number 0 (Antitubercular Agents). 50-24-8 (Prednisolone).

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Unique Identifier:1881499

Authors: van Bommel EF. Stiegelis WF. Schermers HP.

Institution: Department of Internal Medicine, St Clara Hospital, Rotterdam, The Netherlands.

Title: Paradoxical response of intracranial tuberculomas during chemotherapy: an immunologic phenomenon?.

Source: Netherlands Journal of Medicine. 38(3-4):126-30, 1991 Apr.

Abstract: Intracranial tuberculomas are rare in developed countries, occurring mostly in non-Caucasian patients. We describe a white Dutch patient with miliary tuberculosis, who was noted to have intracranial tuberculomas on computed tomographic scanning. During antituberculous chemotherapy the systemic tuberculosis was responding satisfactorily, while intracranial tuberculomas developed or enlarged. Although this caused anxiety and led to some changes in chemotherapy, the lesions eventually disappeared. Possible mechanisms of this paradoxical response are discussed. CAS Registry/EC Number 0 (Antitubercular Agents).

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Unique Identifier:2634730

Authors: Thajeb P. Lie SK. Huang JS. Chen TY. Chiang TR.

Title: Paradoxical enlargement of intracranial tuberculomas during treatment of tuberculous meningitis: report of a case.

Source: Taiwan i Hsueh Hui Tsa Chih - Journal of the Formosan Medical Association. 88(10):1067-70, 1989 Oct.

Abstract: We report a case of a 32-year-old man who showed paradoxical enlargement of pathologically verified intracranial tuberculomas during a course of adequate antituberculous chemotherapy. Serial computed tomographic scans of the brain disclosed this uncommon phenomenon. Total excision of the lesions with concomitant four-combined antituberculous therapy proved successful. Although the mechanism of this paradoxical phenomenon is not well understood, a defective local tissue immune response with gradually increasing maturity of the lesions during antituberculous therapy, which results in poor penetration of these drugs into the lesions, might be a possible explanation. CAS Registry/EC Number 0 (Antitubercular Agents).

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Unique Identifier:2696802

Authors: Niimi A. Yamamoto K. Kurasawa T. Amitani R. Kawai M. Kuze H. Akiguchi I.

Title: The cause of paradoxical growth of intracranial tuberculomas during anti-tuberculous chemotherapy. [Review] [37 refs] [Japanese]

Source: Nihon Kyobu Shikkan Gakkai Zasshi. Japanese Journal of Thoracic Diseases. 27(11):1300-8, 1989 Nov.

Abstract: A case of multiple intracranial tuberculomas diagnosed by enhanced brain CT scan and MRI, which developed during the course of miliary tuberculosis under anti-tuberculous chemotherapy was experienced. Chemotherapy with an increased dose of each agent and corticosteroid was administered, and eventually intracranial tuberculomas nearly disappeared. After 1970, there have been 29 reported cases of intracranial tuberculomas in Japan, which were diagnosed by brain CT and treated with anti-tuberculous agents. Among them, 27 evaluable cases were classified into 3 groups. Group A: Intracranial tuberculomas were proved by CT before chemotherapy in 7 cases. Four of them enlarged during chemotherapy. Group B: During chemotherapy of tuberculous meningitis, neurological symptoms worsened or prolonged, and finally intracranial tuberculomas were found by CT in 9 cases. In 5 of them, after meningitis was improved by chemotherapy, neurological symptoms worsened and intracranial tuberculomas were found. Group C: During chemotherapy of pulmonary tuberculosis or miliary tuberculosis, neurological symptoms appeared and intracranial tuberculomas were found by CT in 11 cases (including our own case). Getting 3 groups together, intracranial tuberculomas seem to have worsened during chemotherapy in 24 out of 27 evaluable cases. In view of response to chemotherapy, these 24 cases can be divided into 2 categories: 1) non-responders to chemotherapy; 2) cases finally cured by chemotherapy ("transient worsening").(ABSTRACT TRUNCATED AT 250 WORDS) [References: 37] CAS Registry/EC Number 0 (Antitubercular Agents).

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Unique Identifier:3148755

Authors: Javaid A. Ayres JG.

Title: Intracranial tuberculoma: paradoxical deterioration during chemotherapy.

Source: JPMA - Journal of the Pakistan Medical Association. 38(11):303-5, 1988 Nov.

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Unique Identifier:3659262

Authors: Teoh R. Humphries MJ. O'Mahony G.

Institution: Chinese University of Hong Kong, Department of Medicine, Prince of Wales Hospital.

Title: Symptomatic intracranial tuberculoma developing during treatment of tuberculosis: a report of 10 patients and review of the literature.

Source: Quarterly Journal of Medicine. 63(241):449-60, 1987 May.

Abstract: Ten patients with intracranial tuberculomata which developed during treatment for tuberculosis are described. The initial infection was meningeal in five, miliary in three and pulmonary in two and all improved after treatment was started. However 10 days to five months (mean two months) after the start of treatment, new neurological symptoms and/or signs occurred that led to the recognition of intracranial tuberculomata. CT brain scans suggested tuberculomata in all 10 patients; there were several lesions in five and histological confirmation was obtained in three cases. Earlier CT brain scans (six weeks to five months before) were carried out in five patients and in none was a tuberculoma seen. After treatment with anti-tuberculous drugs and control of raised intracranial pressure when present, five patients made a full recovery, three were left with mild neurological deficit and in two it is too early to assess the outcome.

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Unique Identifier:6146749

Authors: Chambers ST. Hendrickse WA. Record C. Rudge P. Smith H.

Title: Paradoxical expansion of intracranial tuberculomas during chemotherapy.

Source: Lancet. 2(8396):181-4, 1984 Jul 28.

Abstract: 4 patients with tuberculosis, 3 of whom had tuberculous meningitis, were noted to have tuberculomas on computed tomographic scanning. During antituberculous chemotherapy the intracranial lesions increased in size in all 4 patients at a time when the clinical state and cerebrospinal-fluid abnormalities were improving; in 2 of the patients the regional lymph nodes also enlarged greatly. Though the expansion of the cerebral lesions caused anxiety and led to some changes in chemotherapy, the lesions eventually diminished in size. CAS Registry/EC Number 0 (Antitubercular Agents).

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