颅内结核瘤的临床特点  

Clinical features of intracranial tuberculoma

作　　者：朱光升 莫永保 苏一家 

机构地区：[1]贺州市人民医院神经外科,542899

出　　处：《临床神经病学杂志》2014年第1期64-66,共3页Journal of Clinical Neurology

摘　　要：目的 探讨颅内结核瘤的临床特点.方法 回顾分析8例颅内结核瘤患者的临床资料.结果 以癫痫为首发症状6例,头痛、呕吐等颅内高压表现5例,发热、盗汗2例,偏瘫及共济失调各1例.头部CT增强扫描显示圆形、类圆形或结节状,大环状或分叶状肿物,密度较周围脑组织密度稍高,3例患者肿物内部有钙化,周围见片状水肿带.MRI平扫显示圆形、类圆形或结节状大片异常信号,边缘不规则,TtWI呈低信号,T2WI及Flair呈高信号,其中心呈低信号；增强呈不规则花环、结节状异常强化信号肿块,中央呈等偏低无强化信号区；病变边界清,周围绕以大片水肿信号影.病理检查显示病灶炎性肉芽组织包裹性凝固性坏死部分为干酪样坏死,伴有上皮样肉芽肿结节形成,朗罕氏巨细胞形态典型,抗酸染色未见明确结核杆菌.术后7例恢复良好,1例基底节区结核瘤患者出现肢体偏瘫.患者经规则抗结核治疗12～ 18个月,复查抗结核抗体阴性,血沉正常.结论 颅内结核瘤的临床表现不典型,通常以癫痫、头痛、呕吐等症状为主,部分合并发热、盗汗、偏瘫等症状,影像学检查见典型的“靶环征”.治疗后预后较好.Objective To explore the clinical features of intracranial tuberculoma.Methods The clinical data of 8 intracranial tuberculoma patients were analyzed retrospectively.Results Epileptic seizure was the first symptom in 6 cases,high performance such as headache or vomiting was in 5 cases,fever and sweating were in 2 cases,hemiplegia and ataxia was in 1 case.Brain CT enhanced scanning was showed round,class round or nodular,big ring or lobulated mass,and the mass density was higher than that in surrounding brain tissue.There was calcification in the tumor,and flake edema zone around.MRI showed that enhanced performance was massive round,class round or nodular abnormal signal and irregular edge.Low signal was in T1 WI,high signal was in T2WI and Flair,and low signal in central.Enhanced MRI showed that irregular wreath,nodular irregular enhancedsignal lamp,and centre part was equal low signal zone without reinforcement.The edge of lesions was clear,and flake edema zone around.The pathological exam showed the lesions inflammatory granulation tissue wrapping solid necrosis part was caseous necrosis,and epithelioid granulomatous nodules were formed.Lang＇s typical giant cell was typical.Anti-acid stain has no tuberculosis bacilli.Seven cases recovered well,and paralytic limbs was in 1 case who has tuberculoma in basal ganglia.After regular anti-tuberculous therapy for 12-18 months,anti-tuberculosis antibody was negative,and blood sedimentation was normal.Conclusions The clinical features of intracranial tuberculoma are not typical,and the mainly symptoms are epileptic seizure,headache and vomiting,some patients have fever,sweating and hemiplegia.MRI shows typical “target sign”,and prognosis is good.

关 键 词：颅内结核瘤 临床特点 

分 类 号：R739.41[医药卫生—肿瘤]