brain tuberculoma
Introduction
Introduction to brain tuberculoma Cerebral tuberculoma, an intracranial tuberculous granuloma, is a focal tuberculosis of the brain parenchyma or meninges. Most of them are spread from tuberculosis lesions in other parts of the body to granulomatous lesions formed in the brain, and a few are diffuse tuberculosis. Caused by residual infection of meningitis, the incidence of brain tuberculoma is 1.4%. It can occur in any part of the brain, and there are many people under the curtain, especially in children and adolescents. In recent years, the incidence of brain tuberculoma has declined due to the improvement of living standards and the application of anti-tuberculosis drugs. basic knowledge The proportion of illness: 0.002% Susceptible people: mostly in children and adolescents Mode of infection: respiratory transmission Complications: hydrocephalus headache, nausea and vomiting
Cause
Causes of brain tuberculosis
(1) Causes of the disease
Cerebral tuberculosis is often secondary to tuberculosis in other parts of the body, especially in tuberculosis.
(two) pathogenesis
After the occurrence of hematogenous spread of primary tuberculosis, many tuberculosis bacteria may remain in the central nervous system. Once the cell-mediated immunity changes, the tuberculosis can form small nodules, and these nodules do not spread into the cobweb. The sub-membrane cavity, so it does not form meningitis, but develops in the brain parenchyma, forming tuberculous spheres of different sizes around dense fibers, generally less than 1cm in diameter, these tuberculosis balls are yellow-white or gray-yellow, and surrounding brain tissue The boundary is clear, the center is cheese-like necrotic tissue or granulation tissue. The strong defense ability of the body can completely form calcification, and the central liquefaction rarely forms a simple abscess. The tuberculous nodules on the meninges can expand to form flat tuberculosis.
The lesions are more common in single hair, and can occur in any part of the brain. The cerebellar hemisphere is mainly under the curtain, and the pediatric patients are more common. On the screen, the amount of the parietal lobe is more common, and other brain parenchyma is rare, such as the brain stem and the corpus callosum. The pineal gland can also be found in the ventricles and cerebral cisterns, such as the saddle area, the occipital pool, and the cerebral cerebral horn. It can still be found in the meninges. Multiple people can be collected in the same lobe or both in the left and right cerebral hemispheres and under the curtain. Sometimes The piles can be confined to the surface of the brain. The tuberculoma lesions often have meningeal adhesions, especially in the posterior cranial fossa. Some people count up to 80%. The tuberculosis ball is located in the brain surface in the brain, or in the deep brain. The membrane is hard and has a clear boundary with the surrounding area. The surrounding brain tissue has edema and less blood supply.
Prevention
Brain tuberculosis prevention
Cerebral tuberculoma is an intracranial granuloma secondary to tuberculosis in other parts of the body. Tuberculosis, commonly known as "pulmonary sputum", is a disease mainly transmitted through the respiratory tract. Treatment is mainly prevention, prevention of contact with infectious sources, vaccination after birth. You can get acquired immunity, such as anemia, night sweats, weight loss, fatigue, low fever and other signs of tuberculosis, timely seek medical diagnosis and treatment, and self-isolation, so as not to spread the infection, while using anti-tuberculosis drugs according to doctor's advice, suffering from tuberculosis At the same time, symptoms of intracranial hypertension and brain damage occur, then look for specialists to check, generally do head CT scan or MRI examination, you can diagnose, the systemic type of the disease, first anti-tuberculosis treatment, use anti-tuberculosis drugs according to doctor's advice; limitations Type, surgical treatment, and a good prognosis.
Complication
Brain tuberculosis complications Complications hydrocephalus headache nausea and vomiting
Hydrocephalus is the most common complication of cerebral tuberculoma. It can be caused by coexisting tuberculous meningitis or cerebral tuberculosis obstruction of the ventricular system. In the treatment of brain tuberculosis, hydrocephalus should be performed simultaneously with ventriculo-peritoneal shunt. To relieve the increase of intracranial pressure. With bone and joint tuberculosis, chest wall and cervical lymphatic tuberculosis such as chronic purulent or tuberculous meningitis. Symptoms of increased intracranial pressure and cerebellar dysfunction: patients have headache, vomiting and papilledema, localized brain damage symptoms, nystagmus, limb ataxia and other manifestations.
Symptom
Brain tuberculosis symptoms Common symptoms Lymph node enlargement Ataxia Frail focal symptoms Night sweats
More chronic onset, the course of disease is more than a few weeks, but also the onset is not obvious, the disease course is longer, children can be detected by sudden seizures, according to the clinical presence of active tuberculosis, its clinical manifestations can be divided into systemic type and limitations type.
1. Systemic patients have active tuberculosis lesions of other organs at the same time, manifested as poor general condition, fever, night sweats, fatigue, weight loss, etc. If it is tuberculosis, there may be cough, hemoptysis, chest pain, etc. Others such as lymphadenopathy, Even miliary tuberculosis with tuberculous meningitis, this type is rare, the general condition is heavier.
2. Limitations There are no obvious organs of active tuberculosis in other organs. Clinically, intracranial lesions are the main manifestations of increased intracranial pressure and focal symptoms. Increased intracranial pressure is headache, vomiting, optic disc edema (early occurrence) The rate is about 10% to 27%). The episodes of episodes are the most common epileptic seizures, with an incidence of 85%. There may be hemiplegia, aphasia, visual acuity, etc. The underlying lesions may first appear as an increase in intracranial pressure, followed by Ocular stimuli, ataxia and other focal symptoms, brain stem lesions may first have cranial nerve dysfunction, and later cross sputum, etc. In short, clinical manifestations may be due to single, multiple, size and location of tuberculosis It is also different.
Examine
Examination of brain tuberculoma
Laboratory inspection
In some patients, the erythrocyte sedimentation rate is increased, and the pressure of cerebrospinal fluid examination can be increased to varying degrees. Other indicators are normal or slightly changed. The negative tuberculin test does not exclude tuberculosis, which only indicates that the possibility is small.
Film degree exam
1. CT examination of the stage and results of the tuberculosis ball is as follows:
(1) Early stage (inflammation reaction period): There are few collagen fibers, which are of equal density, showing no mass, surrounded by low-density brain edema, "Funnel-like" in the frontal lobe, and "three-finger" in the top of the occipital occipital region. Strengthen unevenness.
(2) Mid-term (inflammation regression period): Collagen tissue proliferation, containing cheese-like substance, with a small disc-shaped high density, surrounded by low-density brain edema, showing obvious ring-enhancement.
(3) advanced stage (tuberculosis calcification nodule): the lesion is round or oval, the flat scan is high-density shadow, no brain edema; after enhancement, it shows "target sign", that is, the ring strengthens around the central nodule Calcified or enhanced lesions, which are typical of tuberculous globules.
(4) Dural tuberculosis can cause excessive ossification of the skull, similar to meningiomas.
(5) Tuberculous brain abscess, the central area is characterized by a typical low-density area.
2. MRI scans the tuberculosis ball for low or slightly low signal on the T1 weighted image. Most of the signals on the T2-weighted image are not uniform, showing low, equal or slightly higher signal. The cheese-like necrosis of the tuberculosis center is on the T2-weighted image. The high signal can also be a confusing concentric stratified image with a low signal around the envelope and a high signal edema band. This edema band is covered, indicating that the tuberculosis ball is not yet mature, MRI ratio CT scans can show the extent of the lesion. Both the tuberculoma and the glioma of the brainstem show long T1 and short T2 on MRI. Similarly, the edema around the lesion is high on the T2-weighted image. Therefore, the two are It is not easy to identify on MRI images.
Diagnosis
Diagnosis and diagnosis of brain tuberculoma
diagnosis
According to the medical history and clinical manifestations, combined with auxiliary examination, more can be clearly diagnosed, the diagnosis points are the history of extracranial tuberculosis; chronic disease capacity; more common in adolescents and children under 30 years old; the course of disease is mostly subacute; there is intracranial increase and Focal neurological signs, especially seizures.
Differential diagnosis
Cerebral tuberculoma should be differentiated from other infectious diseases in the brain and other intracranial space-occupying lesions. Tuberculous brain abscess cannot be distinguished from other bacterial brain abscesses even by CT and MRI.
Tuberculosis is a type of secondary tuberculosis in adults. It is a round or oval cheese lesion with a fibrous envelope with a diameter of 1.5 cm or more. Generally asymptomatic. Its volume can be changed for a long time, and when the body's resistance is low, it can also spread to form disseminated tuberculosis or liquefy coughing to form a cavity.
