Cerebral tuberculoma in pregnancy (Jan 1975-May 2025): a systematic review and descriptive analysis of 33 published cases
Abstract
Background: Cerebral tuberculoma is an infrequent but life-threatening manifestation of tuberculosis whose diagnosis and treatment are uniquely complicated by pregnancy-related physiological changes. Evidence to guide clinicians remains fragmented and largely anecdotal.
Methods: We systematically searched MEDLINE, LILACS and grey literature to May 2025 for reports of cerebral tuberculoma in pregnant or postpartum women. Twenty-seven studies (24 case reports, 2 descriptive studies, 1 case series) from 20 countries met inclusion criteria, yielding individual-level data on 33 patients. Demographics, clinical features, diagnostics, management and maternal-fetal outcomes were extracted and synthesized.
Results: Median maternal age was 26 years (IQR 23-29). Diagnosis occurred ante-partum in 45% and post-partum in 55%, at a median gestational age of 31 weeks. Headache (59%), fever (56%) and seizures (48%) predominated; cranial-nerve palsies (54%) and focal paresis (50%) were common neurologic signs. Magnetic resonance imaging (MRI) revealed solitary or multiple contrast-enhancing lesions, chiefly supratentorial but infratentorial in 35%. Cerebrospinal fluid (CSF) showed proteinorrachia (n = 10/15) and mononuclear pleocytosis (n = 8/12, 66.67%); positivity of CSF or biopsy interferon-γ release assays (100%, n = 3/3) outperformed CSF culture (33.3%, n = 3/9) and CSF polymerase chain reaction (PCR; 12.5%, n = 1/8). Standard four-drug therapy plus corticosteroids was administered in…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 33 participants or records.
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