중추신경계 결핵종
Central Nervous System Tuberculoma
김재용, 전범석,
소속 상세정보
김재용 ( )
서울대학교 의과대학 임상병리과학교실
전범석 ( )
서울대학교 의과대학 신경외과학교실
KMID : 0359819980270010021
Abstract
결론
중추 신경계 결핵종은 뇌자기공명영상상 특징적인 소견이 있는 경우가 많아 방사선학적으
로, 또한 임상적으로 결핵종이 의심되면 진단적 약물치료를 시행하는 것이 좋은 치료방침으
로 사료된다. 그러나 뇌종양 등과의 감별진단이 어려운 경우는 지체없이 조직학적 진단을
필요로 하며 조직학적 진단시 심한 뇌압 상승 상태가 아니면 정위적 수술 방법이 위치나 크
기에 관계없이 안건하고 정확한 방법이다. 적절한 조합의 약물 투여가 가장 중요한 치료 방
법이며 적절한 기간의 약물 치료시 대부분의 증례에서 완전히 치유되었다.
#초록#
The authors present a retrospective analysis of central nervous system(CNS)
tuberculoma, describing the clinical manifestations, radiological findings, diagnosis,
treatment, and prognosis.
Between February 1984 to December 1996, 22 cases of CNS tuberculoma presenting as
intracranial space occupying lesions were managed at Seoul National University Hospital.
The age of patients ranged from two to 47(mean, 28) years and the male-to-female
ratio was 6 to 16. The diagnosis of CNS tuberculoma was pathologically confirmed in
18 cases, while the remaining four were diagnosed on the basis of clinical manifestations
and radiological findings, The duration of follow-up ranged from 10 months to 7
years(median, 2 years). The results of treatment and prognosis were defined according
to the status of patients on their final visit to the outpatients' clinic.
The symptoms of CNS tuberculoma were seizure(45% of cases), headache(36%), visual
disturbance(18%), and hemiparesis(18%), and in 23 patients(55%), the presence of related
pulmonary tuberculosis was noted. The most common site of CNS tuberculoma was the
frontal lobe; multiple lesions were present in five cases, and brain stem lesions in three.
In 13 cases, CNS tuberculoma was seen as low signal intensity on T2 weighted
magnetic resonance images(MRI). Gadolinium-enhanced T1 weighted MRI showed strong
rim enhancement in ten cases and nodular enhancement in five. as well as characteristic
grape-like conglomerated lesions in six cases. Surgical removal was performed in 13
cases, stereotactic biopsy in two, and biopsy via craniotomy in three, Although
microbiologic study was negative in all 18 cases, diagnosis of CNS tuberculoma was
possible on histological examination. After clinical or surgical diagnosis, a course of
anti-tuberculosis medication was started in all patients. In 18 cases, intracranial lesions
disappeared completely after anti-tuberculosis medication, and during the follow-up
period. there was no evidence of recurrence. In three cases the lesions became smaller
during treatment and symptoms improved. One patients died in spite of medication and
decompressive surgery. Between the group of 13 patients who underwent decompressive
surgery or lesionectomy via craniotomy, and the other group of nine, the outcome of
treatment was not different(p=1,000, Fisher's exact test).
In conclusion, the MRI findings of intracranial CNS tuberculoma are characteristic
MRI findings, In cases of CNS tuberculoma, the treatment of choice is anti-tuberculous
medication after histologic confirmation, though if sufficient clinical data support this
diagnosis, then diagnostic and therapeutic medication without histologic confirmation is
recommanded. Stereotactic biopsy is and ideal method for confirming a pathologic
diagnosis of intracranial CNS tuberculoma, except in the cases in which intracranial
pressure is high.
키워드
Tuberculosis; Central nervous system; Magnetic resonace imaging; Stereotactic surgery;
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