Incidentally detected intracranial dural tuberculoma following head injury, should always be thoroughly investigated to avoid unnecessary surgery-A rare case report

Background: Intracranial Tuberculomas can present as space occupying lesions in brain. But incidentally detected dural tuberculoma in case of head injury are very rare and not reported yet. There is varied presentation of intracranial tuberculomas and can mimics or simulates various diseases radiologically. Case report: A 35 year male presented as a case of head injury with severe headache and vomiting. On computerized tomography head, biconvex iso to hyperdense lesion was seen in left frontal region. It does not seem to be related to head injury, so further evaluation with MRI (Magnetic resonance imaging) brain was planned. MRI brain was suggestive of diffuse and extensive dural involvement in left frontal region with surrounding edema and en plaque meningioma was suspected. Patient was planned for operative intervention and an extensive dural based lesion was found, which turned out to be tuberculoma on biopsy. Patient was kept on antitubercular medications for 12 months. Conclusion: Dural tuberculoma is an unusual lesion with difficult to differentiate on imaging from dural based lesions in cases of head injury. Diagnosis is required to differentiate from en plaque meningiomas as antitubercular therapy is only required in dural lesions as compared to en plaque maningiomas which requires surgery. Clinical history, neurological examination, radiological findings with high index of suspicion are required to diagnose dural tuberculomas.