Pathogenesis of Unusual Intracranial Tuberculomas and Tuberculous Space-Occupying Lesions

Abstract

lcranial tuberculomas in India has to a number of studies analyzing brain tumors that document this group in detail. Dastur and Iyer, 5 Ramamurthi and Varadarajan/2 and Dastur and Desai 7 have each reported that about 20% of all intracranial space-occupying lesions in their series were tuberculomas. The percentage rises to 47% when brain tumors in children under 15 years of age are considered separately. 3 This incidence, of course, contrasts markedly with the almost negligible occurrence of this particular granuloma in many of the recent Western series of brain tumors 1~ and is reminiscent of the older European observations. 9 Method We have studied 70 tuberculomas out of a total of 386 space-occupying lesions operated on and histologically verified during the years 1960-1966. Standard neurological and radiological examinations were followed by operative exploration and pathological examination of the specimen. The manifestations and appearances of the usual type of brain tuberculoma are too well known to be elaborated upon. The great majority (58) of our specimens were from cases of this sort. The purpose of this paper is not to undertake the usual clinical analysis of this material, but to present a discussion of the possible pathogenetic mechanisms underlying some of the unusual types of intracranial tuberculomas. Twelve unusual intracranial tuberculomas or tuberculous space-occupying lesions will be considered under the following headings: 1) incipient types; 2) those associated with the subdural cyst; 3) cystic