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Lower motor neuron facial palsy in CNS tuberculomas

Ira Shah, Drishti Tolani
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.

Clinical Problem:
An 8 years old boy presented with fever for 19 days with left sided upper limb monoparesis and left lower motor neuron (LMN) facial palsy for 1 day. Cerebrospinal fluid (CSF) showed 25 mg/dl proteins, 75 mg/dl sugar and no cells. MRI brain showed multiple granulomas in right thalamus, left frontal cortex, right temporal lobe and right side of medulla and pons. There was no infarct. Chest X-Ray was normal. Mantoux test was positive. He was started on antituberculous therapy (ATT) along with steroids. A month later, repeat MRI showed regression in size of parenchymal granulomas. Steroids were tapered and stopped in 4 months. After one year of therapy, his facial palsy and monoparesis had resolved and MRI showed no change as compared to previous scan. He was continued on same ATT.

How common is LMN facial palsy with CNS tuberculomas?

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