Giant cerebral tuberculoma in pregnancy: review of literature discussion

Abstract

Tuberculosis is endemic in India and world-wide infects one third of population. We are presenting a case report of a pregnant patient with huge intra axial tuberculoma with excellent prognosis. A 29 year old primi gravida had an episode of seizure and fell unconscious during labor. Imaging was ordered immediately to rule out intracerebral space occupying lesion. CT Brain was suggestive of a huge intraparenchymal lesion with midline shift. Right temporo parietal craniotomy was done and whole mass excised completely. Histo pathological examination suggested of caseating granuloma, likely tuberculosis. Seizures are the commonest manifestation of cerebral tuberculosis however in pregnancy it is almost synonymous with eclampsia. MRI has revolutionized the diagnosis of tuberculomas especially MR Spectroscopy which can help us differentiate the lesions from neoplastic ones. The state of pregnancy itself is a double edged sword for the patient. It is considered a state of lower immunity and stress and along with poor nutritional status may lead to exaggerated form of tuberculosis, though more studies are needed to ascertain this. Management of tuberculosis has to be considered post-surgery with anti-tubercular treatment for 18 months. Pregnant tuberculous women generally tolerate primary chemotherapy well. In conclusion it may be said that tuberculomas are rare in pregnancy but have to consider as differential diagnosis.