Case report, case study
https://doi.org/10.21857/9e31lh6v2m
Epileptic seizure as the first manifestation of tuberculosis in a young male
Stela Bukvić
; Department of Neurology, University Hospital Dubrava, Zagreb, Croatia
Iva Mihaljević
; Department of Neurology, University Hospital Dubrava, Zagreb, Croatia
Anđelko Vrca
; Department of Neurology, University Hospital Dubrava, Zagreb, Croatia, School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
Abstract
Introduction: Central nervous system tuberculosis is a life-threatening condition that usually presents
with seizures. It is most frequently seen in low-to-middle income countries where tuberculosis is
endemic.
Case report: A 23-year-old male from Nepal presented to the emergency department after a generalized
seizure that lasted for several minutes, according to his colleagues. He was previously healthy,
except for the minor weight loss and nausea a few weeks prior to this event. A multi-slice computed
tomography (MSCT) of the brain showed multiple ring-enhancing lesions with surrounding edema.
Magnetic resonance imaging was performed to further characterize the lesions. The differential diagnosis
included neoplastic process, cerebral metastases and various infectious diseases. Antiepileptic
therapy was administered during the hospitalization. MSCT of the thorax showed a conglomerate of
enlarged lymph nodes in the right mediastinum. There was also an enlarged lymph node in the right
supraclavicular fossa that was taken for surgical biopsy and the histologic analysis was performed. The
Quantiferon test was positive and the analysis of the lymph nodes showed caseous necrosis as well as
Langhans giant cells and the diagnosis of tuberculosis was confirmed. Antituberculotic treatment was
started and the patient was referred to a specialized hospital for further evaluation and treatment.
Conclusion: The involvement of the central nervous system is rarely seen as the first manifestation of
tuberculosis. However, most seizures caused by it will resolve after a successful treatment of the underlying
CNS tuberculoma.
Keywords
Tuberculosis, Central Nervous System, Tuberculoma, Seizures
Hrčak ID:
312753
URI
Publication date:
22.12.2023.
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