Isolated pontine tuberculoma presenting as horizontal gaze palsy.

A 14-year-old boy presented with inability to move his eyes to the right since one day. There was no history of fever, headache, vomiting or impairment of vision. Vitals were stable while neurological examination revealed right horizontal gaze palsy with contralateral deviation of eyes (Fig. 1a). There was no diplopia, while nystagmus and Doll’s eye movement were absent. Pupillary reflex and fundus examination were normal in both eyes. Respiratory system examination revealed pleural effusion on the left side. A clinical impression of right conjugate gaze palsy with left sided pleural effusion, with the etiological possibility of tuberculosis was kept. Investigations revealed hemoglobin 10g/dL, total leucocyte count in normal range, and erythrocyte sedimentation rate of 37 mm/h. Chest X-ray showed left sided pleural effusion and pleural tap revealed straw coloured fluid, with an Adenosine deanimase of 87.5 U/L. Mantoux test was non-reactive. Computerized tomography of head showed a ring enhancing lesion, 8.7 × 7.9 mm in the posteromedial aspect of the right side of pons with perilesional edema (Fig. 1b).