Cerebral tuberculoma in pregnancy (Jan 1975–May 2025): a systematic review and descriptive analysis of 33 published cases

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. 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. 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 97%, typically > 12 months; 60% underwent neurosurgical biopsy or resection. Maternal mortality was 4.6%, and persistent neurological sequelae occurred in 33.3% of cases ( n = 7/21). Among 26 live pregnancies, preterm delivery occurred in 72%; neonatal complications affected 50%, including congenital tuberculosis (17%) and neonatal death (17%). Although cerebral tuberculoma during pregnancy is rare, delayed recognition contributes to substantial maternal morbidity and adverse neonatal outcomes. Our synthesis underscores the diagnostic value of advanced imaging and CSF interferon-γ assays, supports prolonged first-line therapy with adjunctive steroids, and highlights critical gaps in evidence-based guidelines. Multicentre prospective registries are urgently needed to refine diagnostic algorithms and optimise maternal–fetal care.