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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(02): 178
DOI: 10.1590/0004-282X-anp-2020-0227
Images in Neurology

Calcified intracranial tuberculomas as sequelae of pediatric neurotuberculosis

Tuberculomas calcificados intracranianos como sequela de neurotuberculose pediátrica
Carolina de Medeiros Rimkus 
1   Universidade de São Paulo, Faculdade de Medicina, Departamento de Radiologia e Oncologia, São Paulo SP, Brazil.
,
Thiago Augusto Vasconcelos Miranda 
1   Universidade de São Paulo, Faculdade de Medicina, Departamento de Radiologia e Oncologia, São Paulo SP, Brazil.
,
Leandro Tavares Lucato 
1   Universidade de São Paulo, Faculdade de Medicina, Departamento de Radiologia e Oncologia, São Paulo SP, Brazil.
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A 29-year-old woman with a history of neurotuberculosis at the age of 18 months presented with seizures, abnormal gait, and fluctuations of consciousness level, recovering after anti-tuberculosis treatment. She remained asymptomatic for the next years, except for moderate cognitive impairment. Years later, a brain magnetic resonance imaging (MRI) scan ([Figure 1]) revealed calcified lobulated masses in the brain parenchyma and basal cisterns.

Zoom Image
Figure 1 Magnetic resonance imaging shows multiple lobulated masses with low signal in T1-weighted (A) and T2-weighted (B and C images in the brain parenchyma and basal cisterns, with low signal in susceptibility-weighted imaging (SWI) (D) and phase images (E), compatible with calcifications. Lesions are non-enhancing in post-gadolinium images (F), except for a few peripheral enhancing foci (arrows), corresponding to small vessels.

Intracranial tuberculomas occur in 5–24% of pediatric neurotuberculosis[1] and can be secondary to pial vessel inflammation, perivascular abscesses, or septic emboli[2]. Medical history and the characterization of non-enhancing, diffusely calcified brain masses are important clues for diagnosing residual granulomas.


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Conflict of interest:

There is no conflict of interest to declare.

Authors’ contributions:

CMR: study conceptual design, imaging analysis, writing and review of the manuscript. TAV: imaging and clinical data acquisition, review of the manuscript. LTL: imaging analysis, writing and review of the manuscript.


  • References

  • 1 Chiang SS, Khan FA, Milstein MB, Tolman AW, Benedetti A, Starke JR, et al. Treatment outcomes of childhood tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis. 2014 Oct;14(10):947-57. https://doi.org/10.1016/S1473-3099(14)70852-7
  • 2 Rock RB, Olin M, Baker CA, Molitor TW, Peterson PK. Central nervous system tuberculosis: pathogenesis and clinical aspects. Clin Microbiol Rev. 2008 Apr;21(2):243-61. https://doi.org/10.1128/CMR.00042-07

Address for correspondence

Carolina de Medeiros Rimkus

Publication History

Received: 08 June 2020

Accepted: 25 July 2020

Article published online:
04 July 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Chiang SS, Khan FA, Milstein MB, Tolman AW, Benedetti A, Starke JR, et al. Treatment outcomes of childhood tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis. 2014 Oct;14(10):947-57. https://doi.org/10.1016/S1473-3099(14)70852-7
  • 2 Rock RB, Olin M, Baker CA, Molitor TW, Peterson PK. Central nervous system tuberculosis: pathogenesis and clinical aspects. Clin Microbiol Rev. 2008 Apr;21(2):243-61. https://doi.org/10.1128/CMR.00042-07

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Zoom Image
Figure 1 Magnetic resonance imaging shows multiple lobulated masses with low signal in T1-weighted (A) and T2-weighted (B and C images in the brain parenchyma and basal cisterns, with low signal in susceptibility-weighted imaging (SWI) (D) and phase images (E), compatible with calcifications. Lesions are non-enhancing in post-gadolinium images (F), except for a few peripheral enhancing foci (arrows), corresponding to small vessels.