Parinaud syndrome from tuberculoma of pineal area

Computerised tomography and magnetic resonance imaging [MRI] revealed obstructive hydrocephalus and a pineal mass in a 44-year-old woman who presented with headaches and Parinaud's syndrome. Although there was no major evidence of extracranial tuberculosis, and cerebrospinal fluid obtained during third ventriculostomy contained no leukocytes, stereotactic biopsy of the lesion revealed it to be a tuberculoma. MRI showed resolution of the lesion following antituberculous therapy. The implications of this case with regard to difficulties in the diagnosis of cerebral tuberculoma and the management of pineal region tumours are discussed