Intracranial tuberculomas: an unusual cause of altered mental status in a pediatric patient.

A 2-year-old boy was brought to the Emergency Department (ED) with a complaint of 3-week history of increasing lethargy, weight loss, intermittent low grade fever, and right-sided tremor. A non-contrast computed tomography (CT) scan of the head, ordered by the patient's pediatrician, was interpreted as abnormal and the patient was referred to the ED for further evaluation. Physical examination was remarkable for somnolence requiring tactile stimulation to arouse the patient. Neurologic examination revealed right-sided choreoathetosis and unsteady gait. A contrast CT scan of the head demonstrated multiple ring-enhancing lesions throughout the brain and mild to moderate third and lateral ventricular enlargement. In view of the positive purified protein derivative test, chest X-ray study, and gastric aspirates positive for tuberculosis, a diagnosis of intracranial tuberculomas was made. The epidemiology, clinical presentation, diagnostic evaluation, and management of intracranial tuberculomas are reviewed.