Third Ventricular Glioma Masquerading as Tuberculoma: A Diagnostic Dilemma

Intrinsic third ventricular gliomas are exceptionally rare and pose significant diagnostic and management challenges due to their deep midline location and atypical radiological appearance. These mimic inflammatory or infectious lesions such as tuberculoma, especially in areas where tuberculosis is common. Current case describes the history of a young adult male who presented with progressive headache, vomiting and right-sided weakness. Plain CT scan demonstrated intraventricular hemorrhage and mild obstructive hydrocephalous. MRI findings suggested moderately enhancing third ventricular lesion leading to obstructive hydrocephalus. In view of endemic tuberculosis and radiological ambiguity, empirical antitubercular therapy (ATT) was initiated without improvement. So later he underwent right fronto-temporo-parietal craniotomy and subtotal excision of the lesion. Histopathology confirmed an intraventricular glioma, IHC showed ATRX – Retained, GFAP – Positive, Synaptophysin - Positive for some of the cells, Ki67 - 15 to 18 % and EMA – Negative, thus confirming the diagnosis Pediatric type-high grade glioma, H-3 wild type, IDH wild type (pHGG). The patient was subsequently referred for adjuvant therapy. The case highlights the diagnostic challenge posed by central neuroepithelial tumours which resemble tuberculomas in young patients, particularly in regions with significant tuberculosis is prevalent. An early biopsy or surgical intervention is necessary for a conclusive diagnosis.