Presentation and outcome of patients with intracranial tuberculoma in a high HIV prevalence setting
OBJECTIVE: To describe the clinical presentation, serial brain imaging findings during treatment and outcome of patients with intracranial tuberculoma in a high human immunodeficiency virus (HIV) prevalence setting.
DESIGN: This was a retrospective observational study conducted over a 12.5-year period. Records of adults (age ≥18 years) who presented with neurological TB were screened. We included patients with tuberculoma in whom sequential brain imaging was performed.
RESULTS: Of 66 patients enrolled, HIV status was known in 61; 47 (71%) were HIV-infected and 14 (21%) were non-HIV-infected. Clinical and imaging findings and outcomes were similar between these groups. Persistent tuberculoma was present at 18 months follow-up in 20/41 (49%) patients who underwent repeat imaging at that timepoint; those with persistent tuberculoma were more likely to have persisting neurological abnormalities (85% vs. 52%; P = 0.043). Larger tuberculoma size at presentation (≥3 cm) was the only factor significantly associated with tuberculoma persistence (multivariable logistic regression, OR 19.9, 95%CI 1.27–309.68; P = 0.033).
CONCLUSION: Tuberculoma is a severely disabling TB manifestation regardless of HIV coinfection, with half of patients showing radiologically persistent lesions at 18 months follow-up. Large size of tuberculoma at presentation heralds lower chance of its resolution within 18 months.
Keywords: central nervous system; extra-pulmonary tuberculosis; imaging; treatment response; tuberculous meningitis
Document Type: Research Article
Affiliations: 1: Department of Neurology, Inkosi Albert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, Division of Neurology E8-75, New Groote Schuur Hospital, Cape Town, South Africa 2: Department of Neurology, Inkosi Albert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, Clinical Outcomes Research Unit, Department of Medicine, University of Melbourne, Melbourne, VIC, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia 3: Department of Radiology, Inkosi Albert Luthuli Central Hospital, Cato Manor, Durban, South Africa 4: Department of Neurology, Inkosi Albert Luthuli Central Hospital and University of KwaZulu-Natal, Durban 5: Clinical Outcomes Research Unit, Department of Medicine, University of Melbourne, Melbourne, VIC, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
Publication date: 01 February 2020
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