Abstract

Background: Central nervous system tuberculosis (CTB) is a serious form of tuberculosis (TB), due to haematogenous spread of Mycobacterium tuberculosis (MT). Manifesting as meningitis, cerebritis and tuberculous abscesses or tuberculoma and different presenting forms [1]. In Qatar, the incidence of TB has been increasing in last 10 years.

Case Presentation: 41 years old male with no significant past medical history presented with 7-month history of intermittent episodes of left arm and leg weakness and numbness which last for 10 minutes and subside, episodes are associated with headache and nausea, initially was diagnosed as case of Seizure with secondary paralysis, started on anti-seizure medication physical examination showed weakness mainly in left lower limb, CT head showed ill-defined hyper-dense lesion along the right high parafalcine region , in MRI appeared as Lobulated extra axial Dural based with differential diagnosis includes pachymeningeal/leptomeningeal carcinomatosis, lymphoproliferative disorders (CNS histiocytosis, neurosarcoidosis, Rosai Dorfman disease) and atypical meningiomatosis, patient subsequently underwent open biopsy to reach the final diagnosis.

Conclusion: This is an unusual presentation suggesting that cerebral TB can be misdiagnosed with other conditions as it has different presenting pictures. This necessitates keeping TB in the differential diagnose of the relevant cases, because early recognition and intervention is required to avoid neurological deterioration.