Resolusi Total Klinis dan Radiologis Tuberkuloma Serebral Multipel dengan Klinis Epilepsi Melalui 12 Bulan Terapi Antituberkulosis
DOI:
https://doi.org/10.56260/sciena.v5i4.381Keywords:
Cerebral Tuberculoma, Symptomatic Epilepsy, Radiological ResolutionAbstract
Latar Belakang: Tuberkuloma serebral merupakan manifestasi tuberkulosis sistem saraf pusat yang jarang dan dapat menyerupai neoplasma intrakranial secara klinis maupun radiologis. Variabilitas pencitraan serta persistensi lesi setelah terapi antituberkulosis dapat menimbulkan tantangan diagnostik dan terapeutik. Laporan Kasus: Seorang laki-laki berusia 18 tahun datang dengan riwayat kejang umum tonik berulang selama satu tahun, disertai riwayat batuk kronis, penurunan berat badan, demam hilang-timbul, dan keringat malam. Rontgen toraks menunjukkan tuberkulosis paru dan tes cepat molekuler Mycobacterium tuberculosis positif. CT-scan kepala tanpa kontras awalnya mengarah pada ganglioglioma. MRI otak dengan kontras selanjutnya menunjukkan multipel ring-enhancing lesions pada lobus parietal kanan dan oksipital kiri. Konvergensi temuan klinis, bukti tuberkulosis sistemik, dan pencitraan mendukung diagnosis Tuberkuloma Serebral Multipel dengan Epilepsi Simptomatik. Pasien mendapat terapi antituberkulosis selama 12 bulan dan fenitoin, tanpa kekambuhan kejang. MRI satu bulan setelah terapi menunjukkan resolusi lesi oksipital kiri dan regresi parsial lesi parietal kanan. Tanpa perpanjangan terapi antituberkulosis, MRI 14 bulan setelah terapi menunjukkan resolusi radiologis total. Kesimpulan: Integrasi temuan klinis, bukti tuberkulosis sistemik, dan MRI penting dalam membedakan tuberkuloma serebral dari neoplasma intrakranial. Persistensi lesi residual setelah terapi tidak selalu menunjukkan kegagalan terapi apabila disertai perbaikan klinis yang konsisten. MRI serial berperan penting dalam mengevaluasi respons dan mendokumentasikan resolusi bertahap tuberkuloma.
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