A case of intracranial tuberculoma followed by MRI

: A 62-year-old woman with pulmonary tuberculosis was admitted to our hospital. She was completely neurologically free at admission and her CSF was normal. Brain MRI with Gd-DTPA enhancement demonstrated two mass lesions with ring-enhancement in the left temporal lobe and the right frontal lobe. The left temporal lesion had a bright central core with hypointense periphery on T2 weighted image. Extended hyperintense area was observed around this lesions, which represented brain edema. On T1 weighted image, the central core was demonstrated hypointense and its periphery was isointense. After starting antituberculous therapy, MRI revealed paradoxical expansion of left temporal lesion and neurological symptoms worsened temporarily, but, eventually the intracranial lesions diminished in size and disappeared, and the symptoms improved. So we diagnosed her as having intracranial tuberculoma. By long-term following up with MRI, we observed that the central core of the left temporal tuberculoma had changed gradually to hypointense on T2 weighted image and hyperintense on T1 weighted image respectively. We thought that the change of the central core on MRI represented organization of caseated necrosis.