Late development of resistance to bromocriptine in a patient with macroprolactinoma

Brainstem tuberculoma is exceptionally observed. We report a 44 year-old immunocompetent man with proven diagnosis of miliary tuberculosis (TBC) who developed a complex neurological syndrome characterized by right ophtalmoplegia, left-sided hemiparesis and hemihypoesthesia and a gross ipsilateral postural and action tremor with hand dystonia. A ponto-mesencephalic mass was detected by CT and MRI studies of the brain. Clinical, bacteriological and neuroimaging studies allowed to suspect a ponto-mesencephalic tuberculoma. Long-term therapy with anti-TBC drugs and steroids was started, achieving clinical and imaging improvement which retrospectively confirmed the diagnosis. Although with less amplitude, tremor persisted but a complete disappearance of focal dystonia was observed. The pathogenesis of both abnormal movements is particularly discussed since hand dystonia has never been mentioned in the literature as a consequence of brainstem damage.