Abstract
INTRODUCTION: The threat posed by tuberculosis persists in developing countries. Individuals under the age of five were more likely to develop central nervous system (CNS) tuberculosis. CNS Tuberculoma of the posterior fossa has rarely been reported, and its consequences are more devastating due to the limited space of the posterior fossa. CASE PRESENTATION: A 4-year old male was referred to our academic general hospital with main complaint of decreased consciousness for the last 3 days. The patient has experienced a low-grade fever, cough, and an enlarging neck tumor for two months. Any contact with confirmed tuberculosis patients was denied by the family. A suspected cerebellar abscess and obstructive hydrocephalus led to the patient's referral. Urgent evacuation of the posterior fossa mass was conducted, revealing a histopathological diagnosis of tuberculoma. After the procedure, the patient experienced seizures and no improvement of GCS. A head CT scan evaluation revealed a communicating hydrocephalus. A ventriculoperitoneal shunt is done, resulting in improvement of the patient's consciousness after CSF diversion. DISCUSSION: The haematogenous spread of Mycobacterium, which causes granulomatous foci in the brain, is the cause of CNS tuberculoma. The neuroradiological characteristic of tuberculomas may mimic several conditions. Thorough history-taking and physical examination may lead to a focused differential diagnosis of the patient. Evacuated posterior fossa tuberculoma usually leads to resolved obstructing hydrocephalus. A persistent hydrocephalus leads to the possibility of communicating hydrocephalus due to tuberculous meningoencephalitis. Close monitoring following excision of posterior fossa tuberculoma may help identify persistent hydrocephalus early on. CONCLUSION: CNS tuberculoma should remain a differential diagnosis of ring-enhancing posterior fossa mass, especially in pediatrics. This condition may present concomitantly with tuberculous meningoencephalitis, and it may be presented as a persistent hydrocephalus following the surgical removal of the lesion.