An 82-year-old man presents with left body weakness and neglect

An 82-year-old man with a history of pulmonary tuberculosis in 1947 presents with left body weakness and neglect. Imaging and subsequent biopsy reveal that recurrent tuberculosis was the cause. Mass lesions in the brain of the patient with tuberculosis may develop as a reaction to the tubercle bacillus and consist of

Dysplastic central nervous system (CNS) tissue

Caseating granulomas

Heterotopias

Colobomas

Mesial sclerosis

B. Caseating granulomas

The answer is b. ( Victor, p 759.) Rupture of a large caseating granuloma into the ventricles or the subarachnoid space may produce an abrupt and often lethal deterioration. If the mass becomes large enough before it ruptures, it may in all respects imitate a brain tumor. Such lesions may respond to antituberculous medications even when they are quite large, and the patient may be spared surgical intervention.