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

UNUSUAL PRESENTATION OF TUBERCULOUS BRAIN ABSCESS 43
degree of tuberculin sensitivity, bacillary dose and
route of infection.
Clinical diagnosis of tuberculous brain abscess
may be missed due to its rarity 1 ' 4 ' 6 . It is only when
the pus or excised abscess capsule is examined
that a definitive diagnosis is made 7 ' 9 . The CT
picture of capsular enhancement and central low
density, however, are not sufficient for making a
pre-operative diagnosis of tuberculous abscess 7 .
However, if there is an associated chronic cranial
osteomyelitis, sub-periosteal cold abscess or a
recurrent multilocular brain abscess not
responding to excision and antipyretic treatment,
tubercular origin of the brain abscess should be
strongly suspected. To achieve cure, surgery
(aspiration/excision) followed by antituberculosis
treatment are necessary.
The unique presentation, of the first case,
having extensive tuberculous osteomyelitis of left
parietal bone, producing a massive underlying
brain abscess and an equally large communicating
subperiosteal cold abscess, like a dumbell
cold abscess, has not been described in literature.
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