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Infectious Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Susanna J. Dunachie, Hanif Esmail, Ruth Corrigan, Maria Dudareva
Symptoms include low-grade fever, headache and neck stiffness. Confusion or a reduced Glasgow coma score is present in 30–60%. Cranial nerve palsies occur in 30–50%. Tuberculoma may present with focal neurology or seizures.
Infection-Associated Ocular Cranial Nerve Palsies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Hardeep Singh Malhotra, Imran Rizvi, Neeraj Kumar, Kiran Preet Malhotra, Gaurav Kumar, Manoj K. Goyal, Manish Modi, Ravindra Kumar Garg, Vivek Lal
The appearance of tuberculoma on MRI depends upon whether the lesions are caseating or not (Figure 16.12). The non-caseating granulomas are hypointense on T1-W and hyperintense on T2-W images and shows homogenous enhancement on gadolinium. Caseating tuberculomas are hypo- or isointense on T1-W and T2-W images and may have a solid or a liquified center. Varied amount of perilesional edema may be seen. Liquefaction appears hypointense centrally and hyperintense on T2-W scans with peripheral hypointense rim representing the capsule. Thick ring enhancement is seen on administration of gadolinium.
Non-traumatic neurological conditions in medico-legal work
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Tuberculous meningitis macroscopically has a rather nodular exudate and is most pronounced basally and laterally, particularly overlying the Sylvian fissures (Figure 18.3). Tuberculosis may also present as a parenchymal mass (tuberculoma). The differential diagnosis of granulomatous inflammation of the meninges includes, amongst others, the non-infective condition neurosarcoidosis.
Imaging in Tubercular Choroiditis: Current Concepts
Published in Ocular Immunology and Inflammation, 2020
Aniruddha Agarwal, Alessandro Invernizzi, Ashish Markan, Ilaria Testi, Pearse A. Keane, Rupesh Agrawal, Quan Dong Nguyen, Carlos Pavesio, Vishali Gupta
Choroidal granulomas are characteristic pathological finding in ocular tuberculosis involving the posterior segment of the eye. Unlike the lesions of TB SLC, and other forms of choriocapillaritis (such as APMPPE), choroidal granulomas affect the stroma of the choroid, with secondary changes involving the choriocapillaris. Histopathological examination has shown that granulomas consist of nodular collection of immune cells, usually macrophages and epithelioid cells with surrounding lymphocytes. Granuloma is a host immune reaction to contain the pathogen.2,3 Choroid being the most vascular tissue of the eye is the site for granuloma formation. Choroidal granulomas due to tuberculosis have been termed as tuberculoma by the COTS group. The COTS proposed that the term “choroidal granuloma” is incorrect since a granuloma is a histological term, and preferred using “tuberculoma” instead.7
Clinical Profile of Patients with Tubercular Subretinal Abscess in a Tertiary Eye Care Center in Southern India
Published in Ocular Immunology and Inflammation, 2018
Parthopratim Dutta Majumder, Jyotirmay Biswas, Nishat Bansal, Avirupa Ghose, Hitesh Sharma
Focal tuberculoma or abcess formation in the absence of tuberculosis foci elsewhere in the body is extremely rare. Tubercular abcesses involving the brain,14 retroperitoneum,15 liver,16 and various other organs, have been reported in immunocompetent patients from endemic areas, such as the Indian subcontinent, where no evidence of tuberculous foci was detected in body. It is now clear that formation of an abcess probably represents a different spectrum of tuberculosis infection. It closely resembles a pyogenic abscess instead of exhibiting the prototypic granulomatous changes, seen in tubercles or tuberculomas. Thus, diagnosis of tuberculous abcess requires a high index of suspicion, especially in endemic countries, such as India.
Resolution of Large Choroidal Tuberculoma following Monotherapy with Intravitreal Ranibizumab
Published in Ocular Immunology and Inflammation, 2020
Sahil Jain, Aniruddha Agarwal, Vishali Gupta
Our patient had no microbiological confirmation of active systemic TB. He had a vascular choroidal tuberculoma with massive SRF and exudation indicating the role of VEGF. Intravitreal ranibizumab was used as monotherapy in this patient, and even before his systemic evaluation for TB was complete, the lesion healed and regressed completely. To the best of our knowledge, this is the only case report showing successful resolution of tuberculoma with a single injection of anti-VEGF. Thus far, our patient has remained free from any disease activity. It is imperative to keep the patient under regular follow-up, and consider retreatment with anti-VEGF and/or ATT in case of a future recurrence.