Space occupying lesion in the brain– What is it_?

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Clinical Problem:

Ira Shah
Medical Sciences Department, Pediatric Oncall, Mumbai, India.

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056, India.

A 7 years old boy presented with fever and headache for 1 month, projectile vomiting for 15 days and altered sensorium for 1 day. There was no contact with a patient having tuberculosis. On examination, he had signs of raised intracranial tension. An MRI brain was done that showed obstructive lateral ventricle hydrocephalus with irregularly shaped heterogeneously enhancing periventricular masses in the antero-mesial aspects of both temporal lobes and in medial aspect of right occipital lobe with areas of vasogenic edema and leptomeningeal enhancement. A differential diagnosis of tuberculoma or a neoplasm was considered. The child’s condition was too unstable to do a lumbar puncture. A neurosurgery opinion was taken regarding biopsy of the lesion but was not considered, again due to unstable condition of the child.

How to differentiate between tuberculoma and other space occupying lesions_?

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