Falcine tuberculoma presenting with chronic headache – A rarity
How to cite this article: Taallapalli AV, Shivaram S, Kulanthaivelu K, Nashi S, Kulkarni GB. Falcine tuberculoma presenting with chronic headache – A rarity. J Neurosci Rural Pract 2022;13:804-5.
A 28-year-old man presented to outpatient department in July 2019 with complaints of throbbing type of headache for the past 2 years, once in 2 months, with associated photophobia and phonophobia. Four months before presentation, headache increased in frequency and intensity. He required daily analgesics. He also had tinnitus and giddiness. No nausea, vomiting, cough, fever, and loss of weight. No focal deficits on examination. MRI [Figure 1] showed T2 hypointense, T1 hyperintense nodular enhancing pachymeningeal thickening along the falx cerebri. Furthermore, there was leptomeningeal enhancement along cingulate, marginal, and callosal sulci.
This patient presented with chronic headache without other features of raised intracranial tension, with recent worsening of symptoms. Imaging shows features consistent with pachymeningeal and leptomeningeal thickening with enhancement which favor granulomatous inflammation rather than a tumor.
Computed tomography of chest was normal, hemoglobin − 14.3 g/dl, ESR – 9 m/h, HIV, VDRL – non-reactive, ANA profile, ANCA, Serum Brucella antibody – negative, CSF – normal, Cartridge-based Nucleic Acid Amplification Test – negative, CD4 – 866/mcl, Mantoux was negative.
Biopsy was deferred since patient did not consent and was started on empirical four drug anti-tubercular treatment without steroids from local hospital which was continued pending investigations. Headache reduced within 1 month. MRI repeated [Figure 2] in October, 2019 showed significant resolution and patient is continued on ATT and is on regular follow-up.
Falcine tuberculoma is a rare entity. Any patient with chronic headache with recent worsening needs urgent imaging.[1,2] Falcine lesion with pachymeningeal and leptomeningeal thickening with enhancement is clue for granulomatous inflammation rather than tumor.
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