Unusual Periventricular Hemorrhage as the initial manifestation of Central Nervous System Tuberculosis: A case report

Abstract Background Intracranial hemorrhage (ICH) is a rare complication of central nervous system (CNS) tuberculosis, and intra-tuberculoma hemorrhage is even rarer. Periventricular hemorrhage caused by CNS tuberculosis has not been reported so far. In this paper, we exhibited the peculiar neuroradiological manifestations of periventricular hemorrhage secondary to CNS tuberculosis and discussed possible mechanisms of intra-tuberculoma hemorrhage supported by neuroradiological findings. Case Description We presented a 50-year-old man with headache and periventricular hematoma with intraventricular hemorrhage on initial CT scan. Despite the conventional treatment for ICH, his headache deteriorated and repeated CT scan revealed hematoma expansion. Further investigation demonstrated CNS tuberculosis and tuberculomas lying within the periventricular hematoma. Conclusions ICH may present as the initial manifestation of CNS tuberculosis, and CNS tuberculosis should be suspected when hemorrhage occurs at an usual site or the hematoma expands despite conventional treatment.