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MRI Brain Shows Multiple Tuberculomas In Bilateral Syhian Fissures & Conernous Sinus Region, Advised Biopsy. Is It Necessary ?

my wife, 52 yrs., 12 months back, diagnosed with Hyponatremia & Cryptococcal Meningities and treated accordingly, following with under treatment for Meningities Tuberculasis and on AKT for 11 months. Recently on MRI brain shows multiple tuberculomas in bilateral syhian fissures & conernous sinus region....Dr. has advised for Biopsy of the lesion &C/S. Is it necessary for Biopsy and has any risk or any alternate test can be done? AAAAA, AAAA(AAAA)
posted on Mon, 21 Jan 2013
Twitter Tue, 5 Feb 2013 Answered on
Twitter Tue, 5 Feb 2013 Last reviewed on
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Neurologist,  's  Response
Hi,

Thank you for posting your query.

The initial treatment for tuberculous meningitis was started on empirical grounds (without confirming the diagnosis). If the current MRI had not shown any new findings, then, the doctor would have continued the TB treatment for at least another 7 months.

Since, there are tuberculomas, it is possible that we are dealing with multi-drug resistant TB or some other infection/disease, so, I also agree that biopsy of the brain lesion is the best option at this point.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad
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MRI Brain Shows Multiple Tuberculomas In Bilateral Syhian Fissures & Conernous Sinus Region, Advised Biopsy. Is It Necessary ?

Hi, Thank you for posting your query. The initial treatment for tuberculous meningitis was started on empirical grounds (without confirming the diagnosis). If the current MRI had not shown any new findings, then, the doctor would have continued the TB treatment for at least another 7 months. Since, there are tuberculomas, it is possible that we are dealing with multi-drug resistant TB or some other infection/disease, so, I also agree that biopsy of the brain lesion is the best option at this point. Best wishes, Dr Sudhir Kumar MD DM (Neurology) Senior Consultant Neurologist Apollo Hospitals, Hyderabad