Dr Gurneet Singh SawhneySir, please help me.” It was a busy Monday morning in my OPD when I heard those words. Even before he introduced himself, I could hear the anxiety in Anil’s trembling voice. Frail and slumped in a wheelchair, he was accompanied by his wife who looked visibly distressed. A house help in Navi Mumbai, she had taken time off work to tend to him. An employee at a small workshop, Anil hadn’t been able to report to work for the last few weeks.About a month earlier, he had started losing balance and developed blurred vision. He felt like he’d topple while walking and his speech had turned robotic. Worried, the couple had gone to a hospital to report the symptoms. There, an MRI revealed a large tumour in the pons — a critical part of the brainstem that controls vital functions. Surgery was scheduled, but at the last minute, the hospital backed out, citing high risk. Anil was sent home.
He approached other hospitals but got no clear answers. Exhausted but clinging to hope, he came to us. I saw classic signs of a pontine lesion: abnormal eye movements, slurred speech, unsteady gait, cerebellar swelling. The MRI also showed unexplained cerebellar inflammation and signs of hydrocephalus — fluid buildup in the brain. Something didn’t quite add up.We decided to proceed with a stereotactic biopsy in the brainstem, a delicate, high-stakes procedure called “no man’s land” for a reason — coma or paralysis are real possibilities. You don’t see what you’re doing directly; everything is guided by imaging and meticulous planning. Anil was terrified. “Will this help me? Should I just get the whole tumour removed? Will I survive this?” His earlier experience had left him shaken. I reassured him: without the biopsy, we wouldn’t know what we were truly dealing with. Despite the risks, I was confident we could carry it out safely. He consented.During the awake procedure, Anil chatted with me in Marathi about wanting to return to his village and farm again. “Yes, definitely, we will make that happen,” I promised. But just as I reached the lesion, he suddenly dozed off. The anaesthetist panicked: “Sir, he’s not responding!” I knew what had happened. I had touched the reticular activating system — part of the brain responsible for consciousness. His sudden sleep confirmed we were exactly at the right spot. We took the sample and sent it for frozen section analysis.
Then came a surprising call from the microbiologist: It was TB. I was stunned. I’ve seen TB affect almost every part of the body — except maybe tooth enamel — but the brainstem? That’s extremely rare
Dr Sawhney
The pathologist confirmed abnormal tissue, likely a low-grade tumour. This was expected. But then came a surprising call from the microbiologist: It was tuberculosis (TB). I was stunned. I’ve seen TB affect almost every part of the body — except maybe tooth enamel — but the brainstem? That’s extremely rare. “Are you sure?” I asked. She double-checked. “Yes.”In medical school, we’re taught to look for one unifying diagnosis. But Anil had two: a tumour causing pressure and TB causing inflammation and swelling. This changed everything. We immediately began aggressive TB treatment while managing the tumour conservatively.At first, Anil improved. But within days, he became drowsy again. A follow-up MRI showed worsening hydrocephalus — a known complication when dying TB bacteria block brain fluid pathways.I performed a ventriculoperitoneal (VP) shunt to drain excess fluid and relieve pressure. The results were immediate. His headaches eased, he sat up, and his responses became clearer. He was discharged the next day. A week later, he returned, visibly better. Since then, his recovery has been steady. Anil now walks into my OPD with confidence. “I’m feeling better now,” he tells me. “And I want to feel even better.” That’s my true reward.Neurosurgery is emotionally intense. You witness both miraculous recoveries and devastating outcomes. To cope, I meditate every night. But Anil’s story has stayed with me. Scanning his brain taught me a vital lesson: never assume there’s only one culprit. TB can be a silent player in neurology, and since Anil, I’ve diagnosed other cases where something hidden — like TB — was the missing piece. Medicine isn’t always about finding a neat, singular answer. Sometimes, your gut tells you there’s more to the story. Anil reminded me to trust that instinct and to never stop digging.Dr Sawhney is senior consultant, neurosurgery and spine surgery at A strong mulund & Vashi. He spoke to sharmila ganesan ram
