Introduction: Tuberculoma limited to the meninges as a result of mycobacterium tuberculosis infection is very rare and few cases have been reported on this clinical entity. Although some authors have described solitary forms of this presentation, no one reported a case on this diffuse occurrence. This diffuse pattern made the lesions mimic leptomeningeal gliomatosis on imaging studies.
Case presentation: We present a case of a 72-years old man with a two (2) months history of right lower limb weakness and slurred speech which he initially did not take into a great deal of consideration. He had no cough, fever or chills, syncopal episodes. He has a past medical history of splenectomy and cholecystectomy as a result of a car accident 8 years before. Contrast enhanced MRI performed at our facility showed left diffused temporo-parieto-occipital meningeal thickening with multiple parenchymal nodules.
Conclusions: Leptomeningeal tuberculomas should be suspected in patients who present with diffuse lesions of meninges although solitary or multiple forms of this kind of presentation frequently occur. The progress of the lesions or pathology from the time of first contact with mycobacterium depends on the immune response of the patient as well as the number and type of virulent strains involved. Open surgical biopsy to confirm the diagnosis is a very critical diagnostic step. The main treatment option is anti-TB medication and patients must be followed for a long time with series of imaging studies.