Cerebral tuberculoma, a rare extrapulmonary tuberculosis manifestation, was reported in a 70-year-old man presenting with seizure-like episodes. MRI revealed a 13.6 × 45.1 × 7.9 mm left frontal extra-axial lesion with T1-isointense/T2-hyperintense signals, marked contrast enhancement, and adjacent leptomeningeal thickening. Negative thoracic/abdominal CT and inflammatory CSF findings initially suggested a neoplasm. Histopathological examination of the resected lesion confirmed granulomatous inflammation with acid-fast bacilli, thereby leading to the diagnosis. This case report emphasizes the importance of considering tuberculous granuloma in older patients with intracranial masses and inconclusive CSF studies. Multi-model imaging combined with biopsy remains critical for definitive diagnosis. Early surgical intervention and antitubercular therapy may improve outcomes.