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İNTRAKRANYAL TÜBERKÜLOMLARI OLAN BİR OLGUNUN KLİNİK VE MR ÖZELLİKLERİ

Journal Name:

  • Cerrahpaşa Tıp Dergisi

Publication Year:

  • 1998

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Intracranial tuberculomas are rare in industrialized countries, but still prevail their significance in developing nations. This paper presents a case of intracerebral tuberculoma with special emphasis on clinical characteristics and MRI findings. Observation.- An 18 year-old woman was referred for evaluation of subacutely developed paraplegia, weight loss, nocturnal fever and raised intracranial pressure symptoms. Her paraplegia was attributed to an intracranial parasagittal lesion in the absence of sensory level and sphincter dysfunction. MRI of the brain showed numerous lesions located in the cerebral hemispheres, thalamus, cerebellum and brain stem as well as in parasagittal region which were compatible with tuberculomas. The tuberculomas were iso-intense on T1-weighted images and hyperintense with central hypointensity on T2-weighted images. Although the patient had no pulmonary symptoms, her chest X-ray and chest CAT showed miliary pattern. Following treatment with corticosteroids and antituberculous medication with four first-line agents, the patient improved rapidly and was able to walk without help within one week. All of her symptoms resolved within one month despite the slow resolution of tuberculomas on MRI. Unexpectedly we remarked a paradoxical enlargement of one of these lesions under therapy. intracranial tuberculomas should be considered in patients with progressively developing focal neurological deficits or raised intracranial pressure symptoms and space occupying lesions on MRI.
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Abstract (Original Language): 
Bu yazıda kilo kaybı ve geceleri yükselen ateş zemininde subakut yerleşimli parapleji tablosuyla kliniğimize sevkedilen 18 yaşında bir hasta sunuldu. Hastada gelişmiş olan l. nöron tipi paraplejiye seviye gösteren duyu bozukluğu ya da sfinkter kusuru eşlik etmediği için lezyonun medulla spinalisten çok intrakranyal parasajital bölgede yerleşmiş olabileceği düşünüldü. Nitekim bize başvurmadan öcne yapılmış olan kranyal MR incelemesinde en büyüğü söz konuşu bölgede olmak üzere birçoğu asemptomatik olan ve tüberkülomla (TBM) uyumlu olduğu düşünülen çok sayıda lezyon saptandı. Serebral hemisferlerde, bazal gangliyonlar düzeyinde, serebellumda ve beyin sapında bilateral ve yaygın olarak bulunan lezyonlar T1 ağırlıklı kesitlerde beyin parenkimine göre izointens, T2'lerde bazıları santral hipointensite içeren hiperintens şekilde görünmekteydi. Hastanın akciğerleriyle ilişkili bir yakınması olmamasına karşın akciğerlerin direkt ve tomografik radyolojik tetkiklerinde miliyer tüberkülozla uyumlu görünüm saptandı. Uygulanan steroid ve anütüberküloz tedaviyle klinik olarak hızla düzelme kaydedilen hasta ilk haftanın sonunda yardımsız yürüyebilir hale geldi ve bir ay içinde tamamen iyileşti. Literatür verilerine uygun biçimde, MR lezyonlarının daha yavaş düzelme gösterdiği hatta bir tanesinin boyutlarının daha da arttığı gözlendi. Ülkemiz koşullarında son yıllarda tüberküloz infeksiyonunun artması göz önüne alındığında sundumuz hastada olduğu gibi intrakranyal yer kaplayan bir lezyon düşündüren progressif seyirli nörolojik tablolarda TBM tanışı ilk sırada düşünülmektedir. Günümüzde MR görüntüleme yöntemi TBM gibi güç tanınan beyin lezyonlarının belirlenmesinde en seçkin yöntemdir.
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  • 2
99-106
  • Turkish

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