Question

Management of cerebral tuberculomas.

Hint:

Early diagnosis and prompt treatment with antituberculous drugs and steroids are essential to prevent complications and improve outcomes in cerebral tuberculomas.

Answer 1

Cerebral tuberculomas are localized collections of tuberculosis infection in the brain, often presenting with neurological symptoms due to mass effect or inflammatory responses.
Step 1: Medical Management:
1. Antituberculous Therapy (ATT): - First-line treatment involves a combination of antituberculous drugs, typically isoniazid, rifampicin, pyrazinamide, and ethambutol for a minimum of 6 to 12 months.
- Directly Observed Therapy (DOT) may be used to ensure adherence to the treatment regimen.
- ATT should be started as soon as the diagnosis is suspected, even before culture results are available, to reduce the risk of further progression and complications. 2. Corticosteroids: - Corticosteroids, such as prednisone, are commonly used to reduce inflammation and mass effect caused by the tuberculomas. This helps in minimizing neurological damage and controlling symptoms like headaches and seizures.
Step 2: Surgical Management:
1. Surgical Resection: - If the tuberculomas cause significant mass effect, seizures, or are unresponsive to medical therapy, surgical resection may be considered.
- Surgery is also indicated in cases of abscess formation or if there is suspicion of malignancy.
Step 3: Follow-up and Monitoring:
1. Regular Imaging: - MRI or CT scans are performed periodically to monitor the response to treatment and detect any recurrence of tuberculomas.
- Follow-up with regular neurological exams to assess improvement or development of new neurological deficits. 2. Adherence to Therapy: - It is crucial to ensure that the patient completes the full course of ATT to prevent relapse or development of drug-resistant tuberculosis.