{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T10:40:03Z","timestamp":1772102403739,"version":"3.50.1"},"reference-count":19,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,8,31]]},"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:p>Brainstem tuberculoma is diagnostically challenging as it lacks clinical clues and imaging mimics a high-grade glioma (HGG). We report the case of an adolescent girl diagnosed with brainstem HGG, who was referred to our centre for Gamma Knife. Initial MRI showed a pontomedullary junction, ring-enhancing lobulated lesion demonstrating distinct central hypointensity on T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) images with extensive vasogenic oedema. An alternative diagnosis of infection was entertained, and biopsy was suggested; however, the parents opted for a trial of alternative treatment. Suboccipital craniotomy and debulking were only performed 3\u2009months later when her symptoms worsened, and MRI revealed enlargement of the lesion. A cheesy \u2018tumour\u2019 was noted intraoperatively; histopathological findings later confirmed chronic granulomatous inflammation. In an endemic area, a high index of suspicion of a tuberculoma is vital specifically in the presence of central T2W\/FLAIR hypointensity of a ring-enhancing lesion.<\/jats:p>","DOI":"10.1136\/bcr-2022-251672","type":"journal-article","created":{"date-parts":[[2022,9,15]],"date-time":"2022-09-15T10:56:58Z","timestamp":1663239418000},"page":"e251672","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Tumour-like presentation of brainstem tuberculoma: a lesson learnt"],"prefix":"10.1136","volume":"15","author":[{"given":"Chia Ming","family":"Yeat","sequence":"first","affiliation":[{"name":"Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hairuddin","family":"Achmad Sankala","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faizah","family":"Mohd Zaki","sequence":"additional","affiliation":[{"name":"Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahizon Azura","family":"Mohamed Mukari","sequence":"additional","affiliation":[{"name":"Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,9,15]]},"reference":[{"key":"2025082702424674000_15.9.e251672.1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1989.00520410063025"},{"key":"2025082702424674000_15.9.e251672.2","first-page":"23","article-title":"Central nervous system tuberculosis in children","volume":"1","author":"James","year":"2019","journal-title":"Pediatr Infect Dis"},{"key":"2025082702424674000_15.9.e251672.3","doi-asserted-by":"crossref","first-page":"628","DOI":"10.5114\/pjr.2018.81408","article-title":"Magnetic resonance imaging spectrum of intracranial tubercular lesions: one disease, many faces","volume":"83","author":"Khatri","year":"2018","journal-title":"Pol J Radiol"},{"key":"2025082702424674000_15.9.e251672.4","article-title":"Giant cerebral tuberculoma masquerading as malignant brain tumor \u2013 a report of two cases","volume":"75","author":"Agrawal","year":"2020","journal-title":"Cureus"},{"key":"2025082702424674000_15.9.e251672.5","doi-asserted-by":"crossref","first-page":"204","DOI":"10.4103\/jpn.JPN_78_19","article-title":"Giant tuberculomas of brain: rare neoplastic mimic","volume":"15","author":"Sahu","year":"2020","journal-title":"J Pediatr Neurosci"},{"key":"2025082702424674000_15.9.e251672.6","doi-asserted-by":"crossref","unstructured":"Y-q F . 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