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

42 S.C.TANDON£T/1L
Fig. 4. CT Scan of Case No. 2 showing recurrence of
abscess 15 days after trephine craniotomy and excision
Fig. 3.
CT Scan of Case No. 2 showing large
multilocular abscess in left frontal region
month, without any history of focal infection in
the body. On examination, no neurological deficit
was present except for bilateral gross
papilloedema. X-ray chest was normal. CT Scan
showed multilocular brain abscess with one large
loculus in left frontal region (Fig. 3). Urgent
aspiration was done to relieve raised ICP. Pus
was thick, white-creamy and sterile on culture.
AFB were demonstrated in smear examination.
Aspiration was followed by excision through left
frontal trephine craniotomy. Two weeks later, he
had a recurrence of the symptoms and repeat CT
scan revealed a single large abscess (Fig. 4). The
abscess was excised through the same trephine
craniotomy. Surgery was followed by antituberculosis
chemotherapy. Histopathology of the
abscess wall confirmed tubercular nature of the
lesion. At 3 months' follow up, the patient was
completely normal.
Discussion
According to Whitner 7 , tubercular infection of
the CNS is hematogenous. The host which has
developed hypersensitivity responds to
inoculation of a large number of tubercle bacilli
by exaggerated exudation with massive caseation.
Softening of the caseation is accompanied by
influx of polymorphonuclear leucocytes leading to
true pus formation. Tandon et al 8 have
experimentally produced tuberculous brain
abscess by intracerebral injection of M.
tuberculosis in BCG vaccinated monkeys
protected with chemotherapy. They attributed the
histological difference between abscess and the
usual tuberculoma formation to host resistance,