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The threat posed by tuberculosis persists in developing countries. Individuals under the age of five were more likely to develop central nervous system (CNS) tuberculosis. CNS Tuberculoma of the posterior fossa has rarely been reported, and its consequences are more devastating due to the limited space of the posterior fossa. A 4-year old male was referred to our academic general hospital with main complaint of decreased consciousness for the last 3 days. The patient has experienced a low-grade fever, cough, and an enlarging neck tumor for two months. Any contact with confirmed tuberculosis patients was denied by the family. A suspected cerebellar abscess and obstructive hydrocephalus led to the patient's referral. Urgent evacuation of the posterior fossa mass was conducted, revealing a histopathological diagnosis of tuberculoma. After the procedure, the patient experienced seizures and no improvement of GCS. A head CT scan evaluation revealed a communicating hydrocephalus. A ventriculoperitoneal shunt is done, resulting in improvement of the patient's consciousness after CSF diversion. The haematogenous spread of Mycobacterium, which causes granulomatous foci in the brain, is the cause of CNS tuberculoma. The neuroradiological characteristic of tuberculomas may mimic several conditions. Thorough history-taking and physical examination may lead to a focused differential diagnosis of the patient. Evacuated posterior fossa tuberculoma usually leads to resolved obstructing hydrocephalus. A persistent hydrocephalus leads to the possibility of communicating hydrocephalus due to tuberculous meningoencephalitis. Close monitoring following excision of posterior fossa tuberculoma may help identify persistent hydrocephalus early on. CNS tuberculoma should remain a differential diagnosis of ring-enhancing posterior fossa mass, especially in pediatrics. This condition may present concomitantly with tuberculous meningoencephalitis, and it may be presented as a persistent hydrocephalus following the surgical removal of the lesion. • Diagnosing CNS Tuberculoma is a challenge in pediatrics, since the clinical presentation may be atypical and the radiologic presentation may mimic other conditions. • CNS Tuberculoma of the posterior fossa that leads to obstructive hydrocephalus should be evacuated as soon as possible due to the limited space of the posterior fossa. • Removal of the obstructing mass should lead to resolve hydrocephalus; however, persistence of hydrocephalus should prompt clinician for the possibility of tuberculous meningoencephalitis. [ABSTRACT FROM AUTHOR]

Intracranial tuberculoma is the second most common manifestation of central nervous system (CNS) involvement in immunocompetent tuberculosis (TB) patients and the major cause of death and disability in developing countries due to diagnostic difficulties. Tuberculosis is the most common infectious cause of CNS space-occupying lesions (SOLs) in Indonesia. However, we should consider other infectious causes for the differential diagnosis of CNS SOLs. Clinical presentations, histopathological and microbiological findings of brain biopsy specimens may confirm intracranial tuberculoma diagnosis. We discuss a case of multiple intracranial tuberculomas in a 23-year-old female with diagnosis difficulties at the early stage of illness. [ABSTRACT FROM AUTHOR]

Tuberculosis is a chronic granulomatous infection occurring due to Mycobacterium tuberculosis, a slow growing, gram-positive rod, which is resistant to acid decoloration when stained with aniline dyes. Tuberculosis is endemic in developing countries, but even in the developed countries after an initial decline up to 1980s, the incidence of tuberculosis is on the rise. Central nervous system (CNS) tuberculosis is a serious, often fatal disease predominantly affecting young children. The CNS involvement comprises approximately 10% to 15% of all tuberculosis infections. Granulomatous inflammatory reaction in CNS caused by Mycobacterium tuberculosis may involve the meninges, brain, spinal cord, and the bones covering the brain and spinal cord, and may manifest clinically as tubercular meningitis, tuberculomas in brain, tubercular brain abscess, tuberculous encephalopathy, spinal tuberculosis and tuberculomas. This review focuses on the various patterns of CNS tuberculosis and various modalities used for the diagnosis. [ABSTRACT FROM AUTHOR]

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