Multiple intracranial granulomas.

A 24-year-old man with family history of tuberculosis, in brother, presented with headache, projectile vomiting and unsteadiness of gait of 10 days duration. Physical examination revealed bradycardia, elevated blood pressure, papilloedema and bilateral cerebellar signs with upgoing planters. Computerized tomography (CT) scan of the head (Fig. 1) revealed multiple foci of edema. Magnetic resonance imaging (MRI) of the brain (Fig. 2) revealed multiple rounded ring lesions with regular margins, which enhanced with contrast suggestive of multiple neurocysticercosis. Chest X-ray (Fig. 3) was normal. The patient was treated with measures to reduce cerebral edema but showed only slight improvement. In view of family history of tuberculosis, CT scan of the chest (Fig. 4) was done inspite of a normal X-ray chest. Miliary tuberculosis was seen and patient showed marked improvement once anti-tubercular drugs were added to the treatment regimen. Repeat MRI of the brain done after three months showed significant resolution of the intracranial granulomas. Fig. 1 : CT head showing multiple foci of edema involving both froto-parietal regions and internal and external capsules on both the sides. Fig. 2 : Contrast enhanced MRI of the brain showing multiple well-defined enhancing lesions with peri-lesional edema. Fig. 3 : Chest X-ray Normal.