Aims: Solitary tuberculous brain abscess is a rare clinical entity in childhood in Germany.
Tuberculostatic therapy is well defined. Therapeutic options for complicating communicating
hydrocephalus consist in general in neurosurgical intervention with ventriculo-peritoneal
shunting. Medical options, like the formerly often mentioned Acetazolamide (AZM) are
nowadays less frequently reported.
Case report: We report on a case of a 13-year old girl, who presented with visual disturbances
and papilledema. MRI showed internal hydrocephalus due to an intracranial cerebellar
mass of unknown origin with beginning compression of the brainstem. After neurosurgical
intervention with extirpation and short time external ventricular drainage a tuberculous
brain abscess without meningitis was diagnosed. Postoperatively ventricular drainage
could be suspended. The patient was started on tuberculostatic therapy. She remained
without central nervous problems during the following two month, when a progressive
papilledema due to communicating hydrocephalus was diagnosed. Based on therapeutic
options in tuberculous meningitis the patient was started on AZM in an effort to avoid
surgical therapy. Regression of papilledema was observed during the following months.
The initial dose of 2×125mg was subsequently reduced during a period of 9 month of
AZM-therapy. Only acral paresthesia as side effect were noted on the starting dose.
After ending the tuberculostatic therapy (12 months) and AZM (9 months) the patient
still remains clinically stable without progression of hydrocephalus. Ventriculo-peritoneal
shunting was not necessary.
Discussion: Radiological, infectiological findings as therapeutical options of tuberculous brain
abscess are demonstrated. Acetazolamide as a still valuable conservative option in
complicating communicating hydrocephalus after tuberculous brain abscess is discussed.
