Abducens Nerve Palsy as the Only Presenting Symptom for Solitary Cerebellar Tuberculoma in an Immunocompetent Young Adult

Abstract

Aims: Depending on the location and quantity of tuberculomas, central nervous system tuberculoma can present with a myriad of symptoms and infrequently solely as Abducens nerve palsy. Presentation of Case: An apparently healthy 20-year-old female has been presented here, who had no other neurological deficits other than left lateral gaze palsy and one day history of headache. Discussion: Magnetic resonance imaging of the brain revealed a solitary, peripherally enhancing space occupying lesion of left cerebellum with no evidence of hydrocephalus or meningitis or exudates. Taking in account of the high endemicity of TB in India, it was presumed to be a tuberculoma and was excised surgically via suboccipital craniotomy. Histopathological examination confirmed the diagnosis and the patient improved subsequently on initiation of anti-tubercular drugs and steroids. Conclusion: Despite the low prevalence of solitary infratentorial tuberculomas as compared to metastases and other brain neoplasms in this region, differential of cerebellar or any intracranial tuberculoma should always be borne in mind, whenever any patient presents with any cranial nerve palsy.