Discussion :
This child has presented with gradual spasticity suggestive of pyramidal tract involvement and has signs of raised ICT in form of blurred optic discs. The commonest cause of pyramidal tract involvement without delayed development is hydrocephalus. Other causes that come with predominantly pyramidal tract involvement are white matter disease such as Metaleukodystrophy and Krabbe’s and also adrenoleukodystrophy {X-web addressed} but they also have neuroregression.
This child also has cerebellar signs and thus involvement of cerebellum. Hence, likely diagnosis in this child would be cerebellar space occupying lesion with obstructive hydrocephalus and raised ICT.
Cerebellar astrocytoma and tuberculoma are common cause of cerebellar SOL. However, with CSF showing 100percent lymphocytes, this child would be more likely to have tuberculoma. MRI showed cerebellar tuberculoma with obstructive hydrocephalus that was treated with antituberculous therapy, shunt surgery and steroids.
E-published April 2009, Vol 6 Issue 4 Art No. 20
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