The Indian Journal of Tuberculosis - LRS Institute of Tuberculosis ...

Case Report Ind. L Tub., 1992, 39, 41
UNUSUAL PRESENTATION OF TUBERCULOUS BRAIN ABSCESS
S.C. Tandon 1 , S. Asthana 2 and S. Mohanty 3
(Received on 23.10.1990; Accepted on 17.5.1991)
Introduction
Tuberculous brain abscess is a somewhat rare
manifestation of intracranial tuberculosis, the
usual presentations being tuberculous meningitis
and tuberculoma. Not more than 30 cases of
tuberculous brain abscesses have been reported.
Similar is the situation in India where
tuberculosis is more common 1 ' 2 ' 3 ' 4 ' 5 ' 6 . We are
reporting two such cases, who also had an
unusual presentation.
Case Reports
Case No. 1
A 6 year old male child presented with 4
months' history of headache, vomiting off and on,
high grade fever and progressive loss of weight.
He also had gradually increasing weakness in
right upper and lower limbs for one month. A soft
swelling which had appeared over the top of head
was gradually increasing in size for one month.
He was thin built, had enlarged but discrete
and non-tender bilateral cervical lymph nodes,
and his fundus showed bilateral papilloedema.
Power was Gr. I/II in the right upper and lower
limbs. There was a 5 cm X 10 cm soft, cystic, non
tender, fluctuating swelling over left parieto-
occipital region. ESR was raised. X-ray chest was
normal. CT scan showed a huge hypodense lesion
involving a major portion of left cerebral
hemisphere, with a smooth enhancing wall,
communicating with a large subperiosteal abscess
through the eroded left parietal bone (Fig. 1).
Aspiration of the brain abscess was done through
a drill hole while the scalp abscess was aspirated
seperately. Pus was sterile on culture but acid fast
bacilli were seen in smear examination. Patient
was treated with repeated aspirations and antituberculosis
drugs (Streptomycin, Rifampicin,
Isoniazid and Ethambutol). There was a
remarkable improvement in the clinical condition
and CT Scan done six months later showed
complete disappearance of the lesion (Fig. 2).
The patient is completely asymptomatic now.
Case No. 2
A 22 year old male presented with symptoms
of raised intracranial pressure (ICP) for one
Fig. 1. CT scan of Case no.l showing large
intracerebral abscess, adjacent osteomyelitis
and a large scalp abscess
1. Reader; 2. Senior Resident; 3. Professor and Head, Section of Nurosurgery, Department of Surgery, Institute
of Medical Sciences, Banaras Hindu University, Varansai-221 005.
Correspondence: Dr. S. Mohanty, Department of Surgery, Institute of Medical Sciences, Banaras Hindu
University, Varanasi-221 005.