Multiple ring enhancing lesions in brain: Neurocysticercosis or Tuberculoma? An extremely unusual / uncommon radiological presentation of a common disease: central nervous system tuberculosis

Cerebral tuberculomas is a rare and serious form of tuberculosis (TB) due to the haematogenous spread of Mycobacterium Tuberculosis (MT). Symptoms and radiologic features are nonspecific, leading sometimes to misdiagnosis. Multiple ring-enhancing lesions in the brain often raise many questions about the true diagnosis. It can present as tuberculous meningitis with complications such as infractions of cerebral cortex, cranial nerve dysfunction, brain stem being the site of greatest involvement, hydrocephalus, cerebral edema and tuberculoma. The clinical progression of tuberculous meningitis may be rapid or gradual. Rapid progression is more often seen in young children. The diagnoses can be difficult early in its course and radiographic studies can aid in diagnosis. Tuberculoma may be confused with Neurocysticercosis radiologically, however various distinguishing features exist. We present a case of CNS tuberculosis presenting as multiple tuberculomas causing great difficulty to distinguish with other similar radiological lesions. Keywords: Tuberculoma, Neurocysticercosis, Gene-Xpert, Ring enhancing lesions