Surreal illustration of a tuberculoma within the third ventricle of the brain.

Rare Tuberculoma in the Third Ventricle: A Case Study

Lena Kashyap in Health & Wellness November 2025 • 3 min read.

"Uncommon brain infection mimics tumor, posing diagnostic challenges."

Tuberculosis (TB) remains a significant global health challenge, particularly in developing countries. Tuberculomas, lesions caused by TB in the brain, account for a variable percentage of intracranial space-occupying lesions. The rate fluctuates based on geographical location. The absence of specific clinical signs for tuberculomas located in the third ventricle makes diagnosis difficult unless other signs of TB are present.

Managing these cases can also be challenging, due to the absence of guidelines on the duration of treatment for this rare form of extrapulmonary TB. This article highlights a unique instance of tuberculoma that resembled a primary intraventricular tumor, emphasizing the diagnostic and therapeutic difficulties.

We delve into the intricacies of identifying and treating this condition. The goal is to increase awareness among healthcare professionals and the public about this rare presentation of TB.

Patient Presentation and Diagnostic Journey

Surreal illustration of a tuberculoma within the third ventricle of the brain.

A 10-year-old girl was admitted to the hospital with complaints of severe frontal headaches, progressive vision loss, and tonic seizures in her lower extremities. These symptoms had been progressing for four months. Initial neurological examination yielded normal results, and other tests revealed no fever.

Computed tomography (CT) scans revealed a nodular formation in the anterior portion of the third ventricle, leading to obstructive hydrocephalus. This lesion was enhanced with contrast administration. Doctors initially suspected an intraventricular tumor, like a colloid cyst.

Surgical Intervention: The patient underwent complete removal of the lesion via a subchoroidal approach.
Histological Findings: Histological examination revealed central necrosis surrounded by tuberculous-like granulomas.
Further Testing: The patient showed no signs of TB infection, and HIV serology was negative. Tuberculin skin test and lung radiography were normal. Polymerase Chain Reaction (PCR) confirmed the tuberculous etiology. Cerebrospinal fluid (CSF) examination showed a normal protein level, with only 3 lymphocytes and negative results for bacteriological examination.

Based on these findings, she received antituberculous chemotherapy consisting of Isoniazid, Rifampicin, Pyrazinamid, and Ethambutol for six months. Six years later, the patient is living a normal life and continuing her secondary studies.

Diagnostic and Therapeutic Recommendations

The occurrence of tuberculoma in the third ventricle is rare, often presenting as a pure hypertensive form that mimics a primary brain tumor. This makes diagnosis challenging.

Surgery is recommended to confirm the diagnosis, reduce chemotherapy duration, and minimize toxicity. Complete resection through open or endoscopic surgery, when possible, is desirable.

Early and accurate diagnosis, followed by appropriate surgical and medical management, are critical for positive outcomes in these rare and complex cases.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.11604/pamj.2013.16.5.2815, Alternate LINK

Title: A Rare Third Ventricle Solitary Tuberculoma

Subject: General Medicine

Journal: Pan African Medical Journal

Publisher: Pan African Medical Journal

Authors: Hermann Adonis N’Da, Adéréhime Haidara, Landry Drogba, Louis Kéhableon Derou, Konan Serges Yao, Vincent Ba Zézé

Published: 2013-01-01

Everything You Need To Know

What exactly is a tuberculoma, and why is it relevant to this case?

A tuberculoma is a lesion in the brain caused by Tuberculosis (TB). They occur when TB bacteria infect brain tissue, leading to the formation of granulomas. In this case, it presented as a space-occupying lesion in the third ventricle, an uncommon location, and mimicked symptoms of a brain tumor. Diagnostic methods like CT scans, histological examinations, and PCR tests are crucial for confirming the presence of a tuberculoma.

Why is it so difficult to diagnose a tuberculoma in the third ventricle?

Diagnosis of a tuberculoma in the third ventricle is challenging because its symptoms, such as severe headaches, vision loss, and seizures, can resemble those of other conditions, like intraventricular tumors or colloid cysts. Also, typical tests for Tuberculosis such as tuberculin skin tests and lung radiography may come back negative which adds to the diagnostic difficulty. Advanced diagnostic methods like PCR testing and detailed neurological examinations are crucial for accurate identification.

What was the treatment plan for the patient, and why was that approach chosen?

The patient was treated with antituberculous chemotherapy consisting of Isoniazid, Rifampicin, Pyrazinamid, and Ethambutol for six months. This combination of medications is a standard approach to treating TB infections. The specific duration and choice of medications can vary depending on the location and severity of the infection, as well as the patient's response to treatment. Regular monitoring is also essential to manage any potential side effects and ensure the treatment is effective.

Are tuberculomas only found in the third ventricle, or can they appear elsewhere in the brain?

While this case study focuses on a tuberculoma in the third ventricle, tuberculomas can occur in various other locations within the brain and central nervous system. These include the cerebral hemispheres, cerebellum, and spinal cord. The symptoms and diagnostic approaches may vary depending on the location of the tuberculoma. The third ventricle is a particularly rare location, which is why this case presented unique diagnostic challenges.

What are the long-term implications of this case, and what does it tell us about diagnosing rare conditions?

The successful outcome in this case highlights the importance of early diagnosis and appropriate treatment with antituberculous chemotherapy. The patient was able to return to a normal life and continue her studies. However, long-term follow-up is essential to monitor for any potential recurrence or complications. This also highlights the importance of considering rare manifestations of common diseases, such as Tuberculosis, in differential diagnosis, especially in regions where TB is prevalent.