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Journal of Medical Case Reports
Published in: Journal of Medical Case Reports 1/2017

Open Access 01-12-2017 | Case report

Brain tuberculoma, an unusual cause of stroke in a child with trisomy 21: a case report

Authors: Abdelmoneim E. M. Kheir, Salah A. Ibrahim, Ahlam A. Hamed, Badreldin M. Yousif, Farouk A. Hamid

Published in: Journal of Medical Case Reports | Issue 1/2017

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Abstract

Background

Tuberculosis remains a public health problem in developing countries and is associated with lethal central nervous system complications. Intracranial tuberculomas occur in 13% of children with neurotuberculosis. Patients with trisomy 21 have an increased risk for stroke, which usually stems from cardiovascular defects.

Case presentation

We report a case of a 12-year-old Sudanese boy with trisomy 21 who was presented to our hospital with focal convulsions and right-sided weakness. The results of neuroimaging and histopathological examinations were consistent with cerebral tuberculoma. The patient had a good initial response to antituberculosis drugs and steroids. To the best of our knowledge, this is the first case report of multiple brain tuberculomas described in a child with trisomy 21.

Conclusions

Patients with trisomy 21 have an increased risk for stroke. Our patient had an exceptional case of stroke caused by tuberculoma. The present case emphasizes the need to consider tuberculomas in the differential diagnosis of children with neurological symptoms living in areas of high tuberculosis incidence.
Literature
1.
2.
Rich AR, McCordock HA. The pathogenesis of tuberculous meningitis. Bull Johns Hopkins Hosp. 1933;52:5–37.
3.
Anuradha HK, Garg RK, Sinha MK, Agarwal A, Verma R, Singh MK, et al. Intracranial tuberculomas in patients with tuberculous meningitis: predictors and prognostic significance. Int J Tuberc Lung Dis. 2011;15(2):234–9.PubMed
4.
Thwaites GE, Macmullen-Price J, Tran TH, Pham PM, Nguyen TD, Simmons CP, et al. Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study. Lancet Neurol. 2007;6(3):230–6.CrossRefPubMedPubMedCentral
5.
Nicolls DJ, King M, Holland D, Bala J, del Rio C. Intracranial tuberculomas developing while on therapy for pulmonary tuberculosis. Lancet Infect Dis. 2005;5(12):795–801.CrossRefPubMed
6.
Rajeswari R, Sivasubramanian S, Balambal R, Parthasarathy R, Ranjani R, Santha T, et al. A controlled clinical trial of short course chemotherapy for tuberculoma of the brain. Tuber Lung Dis. 1995;76(4):311–7.CrossRefPubMed
7.
Mukherjee S, Das R, Begum S. Tuberculoma of the brain - a diagnostic dilemma: magnetic resonance spectroscopy a new ray of hope. J Assoc Chest Physicians. 2015;3:3–8.CrossRef
8.
9.
Gropper MR, Schulder M, Sharan AD, Cho ES. Central nervous system tuberculosis, medical management and surgical indications. Surg Neurol. 1995;44(4):378–84.CrossRefPubMed
10.
Cronk C, Crocker AC, Pueschel SM, Shea AM, Zackai E, Pickens G, et al. Growth charts for children with Down syndrome: 1 month to 18 years of age. Pediatrics. 1988;81(1):102–10.PubMed
11.
Yaramiş A, Gurkan F, Elevli M, Söker M, Haspolat K, Kirbaş G, et al. Central nervous system tuberculosis in children: a review of 214 cases. Pediatrics. 1998;102(5):E49.CrossRefPubMed
12.
13.
Akhila K, Mahadevan S, Adhisivam B. Qualitative evaluation of tuberculin test responses in childhood tuberculosis. Indian J Pediatr. 2007;74(7):641–4.CrossRefPubMed
14.
Kilpatrick ME, Girgis NI, Tribble D, Farid Z. The value of the tuberculin skin test in patients with tuberculous meningitis. J Egypt Public Health Assoc. 1996;71(1-2):1–8.PubMed
15.
Del Brutto OH, Rajshekhar V, White Jr AC, Tsang VC, Nash TE, Takayanagui OM, et al. Proposed diagnostic criteria for neurocysticercosis. Neurology. 2001;57(2):177–83.CrossRefPubMedPubMedCentral
16.
Bernaerts A, Vanhoenacker FM, Parizel PM, Van Goethem JW, Van Altena R, Laridon A, et al. Tuberculosis of the central nervous system: overview of neuro-radiological findings. Eur Radiol. 2003;13(8):1876–90.CrossRefPubMed
17.
Selvapandian S, Rajshekhar V, Idikula J, Chandy MJ. Predictive value of computed tomography-based diagnosis of intracranial tuberculomas. Neurosurgery. 1994;35(5):845–50.CrossRefPubMed
18.
Garg RK, Desai P, Kar M, Kar AM. Multiple ring enhancing brain lesions on computed tomography: an Indian perspective. J Neurol Sci. 2008;266(1-2):92–6.CrossRefPubMed
19.
Pearson E, Lenn NJ, Cail WS. Moyamoya and other causes of stroke in patients with Down syndrome. Pediatr Neurol. 1985;1(3):174–9.CrossRefPubMed
20.
Boggs S, Hariharan SL. An uncommon presentation of stroke in a child with trisomy 21. Pediatr Emerg Care. 2008;24(4):230–2.CrossRefPubMed
21.
Jacobs RF, Sunakorn P, Chotpitayasunonah T, Pope S, Kelleher K. Intensive short course chemotherapy for tuberculous meningitis. Pediatr Infect Dis J. 1992;11(3):194–8.CrossRefPubMed
22.
De Angelis LM. Intracranial tuberculoma: case report and review of the literature. Neurology. 1981;31(9):1133–6.CrossRef
23.
Tola HH, Tol A, Shojaeizadeh D, Garmaroudi G. Tuberculosis treatment non-adherence and lost to follow up among TB patients with or without HIV in developing countries: a systematic review. Iran J Public Health. 2015;44(1):1–11.PubMedPubMedCentral
24.
Afghani B, Lieberman JM. Paradoxical enlargement or development of intracranial tuberculomas during therapy: case report and review. Clin Infect Dis. 1994;19(6):1092–9.CrossRefPubMed
25.
Bhagwati SN, Parulekar GD. Management of intracranial tuberculoma in children. Childs Nerv Syst. 1986;2(1):32–4.CrossRefPubMed
Metadata
Title
Brain tuberculoma, an unusual cause of stroke in a child with trisomy 21: a case report
Authors
Abdelmoneim E. M. Kheir
Salah A. Ibrahim
Ahlam A. Hamed
Badreldin M. Yousif
Farouk A. Hamid
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2017
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-017-1258-7

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