Tuberculoma of Eloquent Brain

A 26-year-old woman with a low socioeconomic background living in rural northwest India presented with a longstanding headache that had worsened during the past 2 weeks and was associated with multiple episodes of vomiting and weakness on the left half of her body. Her past history did not suggest an immunocompromised state, comorbidities, or contact with tuberculosis. A general physical survey, including her nutritional status, was normal. Neurological examination revealed left hemiparesis and upper motor neuron facial paresis. Magnetic resonance imaging revealed a ringenhancing lesion with perilesional edema in the basal ganglia and thalamic region (Figure The center of the lesion was markedly hypointense on T2-weighted imaging, suggesting caseous necrosis (Figure The typical appearance suggested a tuberculoma, which was confirmed with stereotactic biopsy.