Cranial CT in Galactosemia

Before the advent of antituberculous agents, complete surgical excision of intracerebral tuberculoma offered the only chance for survival , generally with poor results 111 . Currently, however, these agents are the treatment of choice for CNS tuberculoma, with surgery reserved for cases of uncontrolled intracranial pressure of failure of medical therapy [21 . Symptomatically, neoplastic and vascular lesions of the brain stem and infection can have similar presentations [1 , 3, 51 . Unless a primary focus of infection is identified , histologic confirmation of an intracranial lesion is mandatory before any therapy is started. Because of its contrast resolution and multiple projections, MR has been shown to be superior to CT for imaging brainstem lesions [6, 71. As documented by the present case, the true extent of the tuberculoma and its precise relationship to adjacent structures could not be fully appreciated by CT. Use of MR in areas edemic for tuberculosis will allow further characterization of this granulomatous process. Despite their sensitive locations, biopsy of brainstem lesions can be accomplished with minimal disruption of normal tissue (8]. Further application of MR and MR-directed stereotaxis will provide precise three-dimensional localization of brainstem lesions, increasing the likelihood of successful biopsy with diminished risks.