Thalamic Tuberculoma Presenting as Isolated Gait Disturbance Without Systemic or Meningeal Symptoms in a 2-Year-Old Child: A Case Report

Background Intracranial tuberculoma is an important manifestation of pediatric central nervous system tuberculosis, especially in endemic regions. While seizures and signs of raised intracranial pressure are common presenting features, isolated focal neurological deficits without systemic or meningeal symptoms are rare, resulting in diagnostic delay. We report an unusual case of thalamic tuberculoma presenting primarily with gait disturbance in a young child. Case Presentation : A 2-year-old boy from Karachi, Pakistan, presented with increasing difficulty ambulating and unable to walk on his own. On neurological examination slight weakness on the left side. An MRI scan of his brain showed that a ring-enhancing lesion in the right thalamus extended into the midbrain, and it was surrounded by vasogenic edema. Magnetic resonance spectroscopy suggested an infectious etiology, most likely tuberculoma. There were no meningeal symptoms, fever or seizures in the child. There were no abnormal findings on routine laboratory testing and chest X-ray, however, screening at home confirmed latent TB exposure. Clinical Discussion : Although intracranial tuberculoma does not always present with systemic manifestations of tuberculosis in children as observed in the present study, it is also a challenging disease to diagnose in young children due to the atypical presentation. Neuroimaging: Early diagnosis is possible. For deep-seated lesions where operative therapy and surgical treatment are highly risky, conservative management is often effective with anti-tuberculous therapy and adjunctive corticosteroids. Early physiotherapy is important for achieving functional recovery. Conclusion The case illustrates the need for consideration of intracranial tuberculoma in an individual neurological impairment case, considering children with isolated neurological deficits, when systemic forms of tuberculosis do not develop, even in the absence of evidence of systemic tuberculosis symptoms. Prompt imaging and early development and treatment with early anti-tuberculous therapy may give good results.