Brief Answer:
Antitubercular medication may be started after ruling out other causes

Detailed Answer:
Thanks for posting on HealthCareMagic. I have gone through the details and reports attached. I am sorry to hear about your daughter. But let me mention that tuberculosis is pretty common in XXXXXXX and we are often unaware that the bacteria is practically always around, and even children could get infected. But let me also mention that tuberculosis may not be the only possible cause of multiple ring enhancing lesions in brain as in her case. Other possibilities apart from tuberculoma could be:
* cerebral abscess
* neurocysticercosis
* some cancerous or non cancerous growths like glioblastoma multiforme and lymphoma - in immunocompromised patients including metastasis if applicable
* subacute infarct / haemorrhage / contusion
* demyelination (incomplete ring)
* tumefactive demyelinating lesion (incomplete ring)

Since I cannot examine the child in detail and cannot go through all the MRI plates of both the spine and brain including detailed analysis of the history, it is really hard to be precise and you need to discuss it with your treating physician and take the appropriate steps at the earliest.

About the next steps of treatment, they could be:
1. Getting a TB quantiferon gold test done for confirmation of tuberculosis. Alternatively, a lumbar puncture for evaluation of cerebro spinal fluid (CSF) could also be done. If there is strong suspicion tuberculosis or tuberculoma, antitubercular drug regimen would need to be started. Please proceed only after discussing with your doctor.
2. Please talk to your doctor if he thinks that the causes that I mentioned, are likely.
3. If the doctor finally feels appropriate to start antitubercular medication which consists or three or four medicines that need to given for at least 6 months. With proper teatment, it will get completely cured and you need not worry.
4. She may start going back to her school but after around two weeks of starting the antitubercular medication if advised by your doctor.

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Brief Answer:
Consult a neurologist

Detailed Answer:
Thanks for writing back. You should visit a neurologist (neuro-medicine). He would be able to evaluate the MRI plates properly and suggest if tuberculoma is the most likely cause or whether other causes need to be considered as well. He will also be able to undergo the lumbar puncture which might help in pinpointing the cause. Based on his imputs about the possibility of tuberculosis, you should then visit a government tuberculosis control cente (genrally available at each municipality) and produce the reports of the neurologist. Based on that, the treatment can proceed in the appropriate direction.

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Brief Answer:
Let doctors discuss and finalise line of treatment

Detailed Answer:
Thanks for writing back.

I have seen the attached report carefully and am still at the same point as I was when I gave the last answer. I understand that your daughter is suffering. I would hope that the present treatment works out for her.

I am sure that the two doctors have considered the other possibilities before proceeding further with the treatment. It is good to hear that your doctor would go in for a panel discussion about this case. The case is indeed a bit complicated and expert opinion is needed.

I would really hope that your daughter finally gets the proper treatment and recovers at the earliest.

Regards

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