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April 1991

Brain-Stem Tuberculomas

Author Affiliations

Department of Neurosurgery The Hitchcock Clinic 2 Maynard St Hanover, NH 03756

Arch Neurol. 1991;48(4):359. doi:10.1001/archneur.1991.00530160019005

To the Editor.  —It was with great interest that I read the article on brain-stem tuberculomas by Talamas et al.1 I am concerned about the diagnosis in patients 3 and 8. In both these patients, there were single, isolated brain-stem masses and neither had evidence of systemic tuberculosis. Diagnosis in these patients was based either on the disappearance of the lesion in the computed tomographic scan (patient 3) or clinical improvement (patient 8), following antituberculous therapy. Our experience shows that these criteria are not foolproof. For a number of years single, small, enhancing lesions noted on computed tomography in Indian patients with seizures were diagnosed as tuberculomas and treated accordingly on the basis of the above criteria (ie, disappearance on the scan or clinical improvement with antituberculous therapy).2 After excision biopsy specimens (using computed tomographic-guided stereotaxic localization) were obtained in 15 consecutive patients, we proved that, in nearly

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