隱球菌腦膜炎之頭部電腦斷層造影

CRANIAL COMPUTED TOMOGRAPHY (CT) OF CRYPTOCOCCAL MENINGITIS

簡肇棟(Chao-Tong Chien) ； 黃國茂(Kou-Mou Huang) ； 王博正(Bor-Jen Wang) ； 錢本文(Poon-Ung Chieng) ； 蔡世傑(Shih-Chieh Tsai)

《中華放射線醫學雜誌》 12卷3期 (1987/09) Pp. 257-261

摘要

自民國70年11月至民國75年8月，共有23位病人（13位男性，10位女性，平均年齡37.2歲）證實有顱內隱球菌感染症（intracranial cryptococcosis），且均曾接受過頸部電腦斷層造影檢查（computed tomography,CT）。19位病人（82.6%）在病發前無特殊病史。只有17位病人接受對比劑造影檢查，其中52.9%（9/17）呈現軟腦膜炎；17.6%（3/17）呈現局部腦炎；17.6%（3/17）呈現基底核梗塞；4.3%（1/17)呈現多發性環狀加強顯影腫塊；有1位全身世紅斑性狼瘡的病人則同時呈現腦萎縮，軟腦膜及水腦症。就全部23位病人而論，43.5%（10/23）呈水腦症；34.8%（8/23）且腦水腫；17.4%（4/23）呈現無不正常發現；而前述全身性紅斑性狼瘡病人則同時呈現腦萎縮，軟腦膜炎及水腦症。就3位呈現基底核梗塞之病人而言，其平均年齡為56.3歲，比全部病人之平均年齡高出甚多，因此與較年輕的病人比較，年齡大的病人被認為較容易罹患基底核梗塞。除此以外，我們發現：各種不同的CT表現中，其死亡率之差異在統計學上不具意義。

並列摘要

From November 1981 to August 1986, there were 23 patients (13 men and 10 women) proved to have intracranial cryptococcosis. All 23 patients underwent at least one cranial computed tomography (CT) during hospitalization. Only 17 cases studied with contrastenhanced CT among them, 9 cases (52.9%) showed leptomeningitis; 3 cases (17.6%) showed focal encephalitis; 3 cases (17.6%) showed focal low attenuation lesions without enhancement at basal ganglia and only 1 case (5.9%) showed multiple rim enhancing lesions. A patient with predisposing systemic lupus erythematosus (SLE) showed brain atrophy and hydrocephalus associated with leptomeningitis. Among all 23 patients, there were 10 cases (43.5%) of hydrocephalus; 8 cases (34.8%) of brain edema; and only 4 cases (17.4%) showed negative CT. Lastly, brain atrophy associated with hydrocephalus and leptomeningitis were found in previous mentioned SLE patient. The cases who showed focal low attenuation lesions without enhancement aged 46, 61 and 62, respectively. Consequently, eldery patients were speculated to be more apt to sustain basal ganglia infarction as compared with younger patients. The overall mortality rate in our study was 47.8% (11 in 23 cases). We presented this study trying to make more understanding in this disease.