An en-plaque tuberculoma mimicking meningioma: A case report and literature review

Background: CNS tuberculomas tend to be intra-axial in most cases but extra-axial lesions are also rarely encountered An en-plaque or dural-based tuberculoma is an extremely rare form of intracranial tuberculosis that mimics varieties of primary or secondary meningeal tumors. the neurosurgeon and other physicians involved in the management should be well versed with the clinical presentations and imaging features for prompt and accurate diagnosis as well as proper subsequent management.Case description: A 40 years old female patient presented with a progressively worsening headache of 6 months duration associated with visual blurring of the left eye and behavioral change. Her physical was unremarkable and baseline laboratory investigations were in the normal range. MRI of the brain showed a right frontoparietal dural-based mass with heterogeneous contrast enhancement and moderate perilesional edema. Craniotomy and GTR of the mass was done with an impression of meningioma to rule out tuberculoma. Histopathology confirmed tuberculosis and the patient was discharged after initiation of Antitubercuos therapy.Conclusion: Knowledge of the imaging features of en plaque tuberculoma is crucial for accurate preoperative diagnosis and optimal management of this rare entity. PCR and MRS can help consolidate the diagnosis at times of difficulty to differentiate from a meningioma.