Computed Tomography of Neurotuberculosis

中樞神經結核之電腦斷層造影

陳震宇(Chene-Yu Chen) ； 何善平(Peter S. P. Ho) ； 陳復華(Fu-Hua Chen) ； 李超群(Chau-Chinn Lee)

《中華放射線醫學雜誌》 15卷3期 (1990/09) Pp. 167-173

摘要

過去五年，我們使用電腦斷層造影檢查25例結核性腦膜炎和7例腦結核瘤病患；25例結核性腦膜炎病例中，有44%的電腦斷層造影結果是完全正常的，另外40%顯示對比增強之基底池滲出物，36%有交通性水腦。2例結核性腦膜炎發生基底血管炎而造成腦梗塞。7例腦結核瘤均顯示對比增強之結節或環形病灶，並伴隨著不同程度的大腦白質水腫。三例結核腦膜炎在治療期間內發生腦結核瘤。1例多發性腦結核瘤經內科治療後，多數結核瘤均已消失，惟左顯葉結核瘤不正常變大，繼續使用相同藥物治療，病人臨床症狀穩定，隨後的電腦斷層造影顯示病灶不再繼續變大且腦水腫消失。我們的經驗可歸納如下：
(1)中樞神經結核之電腦斷層造影無專一性。
(2)使用內科治療中樞結核，電腦斷層造影是最好的臨床治療指標。
(3)對於結核性腦膜炎治療期間所併發的結核瘤，或不正常變大的結核瘤，應根據臨床症狀來決定是否繼續內科治療，通常不需改變抗結核藥物或進行外科手術。

並列摘要

Twenty-five cases of tuberculous meningitis and 7 cases of cerebral tuberculomas have heen studied by computed tomography (CT) in the past 5 years at Tn-Service General Hospital. Among Cases of tuberculous meningitis, 44% demonstrated normal CT, in contrast to 40% enhancing basal exudate and to 36% communicating obstructive hydrocephalus that showed on CT contrast studies. Seven cases of cerebral tuberculomas presented good enhancing nodules or rims on contrast CT. Three cases developed temporal lobe tuberculomas within 6 months after anti-tuberculous treatment for meningitis. One case of multiple tuberculomas showed paradoxical expansion of one tuberculoma in temporal lobe and disappearance of the others. To sum up, CT is a good image modality to monitor the response of antituberculous treatment. Tuberculoma which develops during treatment of tuberculous meningitis or paradoxical expansion of tuberculoma during treatment might not indicate a change of anti-tuberculous regimens being needed. Usually, an enhancing basal exudate on CT denotes a poor prognosis.

並列關鍵字

CNS tuberculosis ； Compouted tomography