CEREBELLAR TUBERCULOMA : LAPORAN KASUS CEREBELLAR TUBERCULOMA : A CASE REPORT

• Aulia Rahma Isnaeni

  Author

abstrak 

Latar Belakang: Tuberkuloma serebelar merupakan salah satu manifestasi tuberkulosis sistem saraf pusat yang jarang terjadi, namun memiliki angka morbiditas dan mortalitas yang tinggi jika tidak ditangani secara tepat. Penanganan dini dan diagnosis yang tepat sangat penting untuk memperbaiki prognosis pasien.

Presentasi Kasus: Seorang laki-laki usia 21 tahun, datang ke Unit Gawat Darurat dengan penurunan kesadaran, demam, nyeri kepala, mual, muntah, batuk berdahak, keringat malam serta penurunan berat badan. Pemeriksaan laboratorium cairan serebrospinal didapatkan hasil warna xantokrom, peningkatan leukosit dan protein serta hasil serologi positif untuk beberapa infeksi. CT scan kepala menunjukkan ring enhacement lesion di hemicerebelli kanan dengan edema vasogenik dan hidrocefalus non-komunikans. Diagnosis tuberkuloma serebelar ditegakkan, dan pasien mendapat terapi OAT lini pertama serta perawatan suportif.

Diskusi: Tuberkuloma serebelar dapat menimbulkan gejala mirip tumor otak atau abses. Pada kasus ini, diagnosis didukung oleh temuan CT scan dan hasil cairan serebrospinal. Terapi utama adalah pemberian OAT jangka panjang dengan kortikosteroid.

Kesimpulan: Tuberkuloma serebelum merupakan manifestasi langka dari TB aktif. Pencitraan radiologis memegang peranan penting dalam diagnosis dan pemantauan penyakit ini. Penampakan tuberkuloma pada CT scan pasien kami menunjukkan ring enhacement lesion. Tuberkuloma intrakranial harus diobati secara konservatif, karena sebagian besar lesi ini sembuh total dengan Obat Anti-Tuberkulosis (OAT).

abstract

Background: Cerebellar tuberculoma is a rare manifestation of central nervous system tuberculosis (CNS-TB), yet it carries a high risk of morbidity and mortality if not diagnosed and managed appropriately. Early intervention and accurate diagnosis are essential to improve tpatient outcomes.

Case Presentation: A 21-year-old male presented to Emergency Room with decreased consciousness, fever, headache, nausea, vomiting, productive cough, night sweats, and significant weight loss. Cerebrospinal fluid (CSF) analysis revealed xanthochromia, elevated leukocyte count and protein levels, along with positive serological results for several infections. Cranial computed tomography (CT) scan demonstrated a ring-enhancing lesion in the right hemicerebellum, accompanied by vasogenic edema and non-communicating hydrocephalus. A diagnosis of cerebellar tuberculoma was established, and the patient received first-line anti-tuberculosis therapy (ATT) along with supportive care.

Discussion: Cerebellar tuberculomas can clinically mimic brain tumors or abscesses. In this case, diagnosis was supported by neuroimaging findings and CSF analysis. The cornerstone of treatment involves prolonged administration of ATT combined with corticosteroids to reduce  nflammation and intracranial pressure.

Conclusion: Cerebellar tuberculoma is an uncommon form of active tuberculosis. Radiological imaging plays a pivotal role in both diagnosis and monitoring of disease progression. In our case, CT imaging revealed a characteristic ring- enhancing lesion. Intracranial tuberculomas should be managed conservatively, as most lesions resolve completely with appropriate anti-tuberculosis pharmacotherapy

1. Aulia Rahma Isnaeni

   Fakultas Kedokteran YARSI

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