Brainstem tuberculoma mimicking glioma in a high TB-endemic region

Rationale: Brainstem tuberculomas account for < 0.2% of all intracranial tuberculomas and predominantly occur in children and adolescents; adult cases are extremely rare. Patient concerns: A 55-year-old male of Yi ethnicity presented with a 4-week history of progressive dizziness, gait instability, and left facial numbness. Brain magnetic resonance imaging revealed a 2.5 × 2.3 cm brainstem lesion with irregular rim enhancement and surrounding T2‑weighted fluid‑attenuated inversion‑recovery hyperintensity. Diagnoses: Brainstem space-occupying lesion, high suspicion of tuberculoma. Interventions: After 4 weeks of diagnostic antituberculosis therapy failed to achieve clinical improvement, gross total resection of the lesion was performed via a retrosigmoid approach, with intraoperative streptomycin irrigation. Outcomes: Histopathological examination confirmed tuberculous granuloma. The patient recovered well and received a standardized 12-month Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol antituberculosis regimen postoperatively. Lessons: For patients with brainstem space-occupying lesions in tuberculosis high-burden regions, etiological examinations should be initiated early, even in the absence of typical systemic symptoms and positive serological findings. Surgical resection serves as an effective strategy to relieve mass effect for patients with severe space occupation.