非尋常顱內結核瘤－病例報告

Uncommon Intracranial Tuberculoma-A Case Report

鄧鐘泉(Jong-Chyou Deng) ； 許燿東(Yaw-Don Shen) ； 張民基(Ming-Key Chang) ； 曹汶龍(Wen-Long Tsao)

《Journal of Medical Sciences》 10卷3期 (1989/06) Pp. 187-192

摘要

顱內結核瘤雖然少見，但在某些開發中國家，可佔顱內腫瘤之30%，尤其在我國，結核病症已漸減少，然仍須列入鑑別診斷。目前因抗結核藥物進步，一旦診斷確定，並不須要外科手術治療，一般在服用結核藥6至8週，臨床症狀或電腦斷層檢查均有明顯進步。本篇報告一例不尋常臨床變化的病患：一位30歲男性，因全身性抽搐症住進本科，早期的腦部斷層掃描為一多達30多個對顯影劑呈高影像反應的病灶，同時胸部X光檢查亦不正常，在早期懷疑腦都為轉移性病灶，其胸腰椎X光檢查第十二節胸椎至第二節腰椎有溶骨侵蝕現象，經由椎骨穿刺檢查發現有耐酸性桿菌（acid-fast bacilli），並開始服用抗結核藥物治療，八週後，臨床症狀顯著進步，腦部斷層追蹤被查，大部份病灶消失。但在六個月後的腦割斷層檢查卻發現：左側顳葉有一單一病灶反而擴大，這一不尋常的現象，我們認為可能是在抗結核藥物治療中，因結核菌釋放出結核蛋白，而引起另一種發炎反應的現象，根據文獻報告，這種情形並不需立即手術治療，故提出報告。

關鍵字

顱內結核瘤 ； 抗結核治療 ； 結核病症

並列摘要

The intracraniaI tuberculoma is rare disease in developed countries, but in developing contries, tuberculoma should be incIuded the differentiaI diangosis in brain lesions. We present a case of multiple intracraniaI tuberculoma with initial manifestations of headache' increased intracranial pressure, fever and seizure. He also had suffered from pulmonary military tubercuclosis and 12th thoracic spine TB osteomyelitis, which was proved by aspiration biopsy. On admission, the CT of brain showed marked brain edema with multiple enhanced lesions which were more than 30 in number and in polymorphic pictures. After antituberculous chemotherapy for 6 months, the multiple intracranial lesions were almost subsided completely, except the left temporal one. According to the recent literatures, the paradoxical expansion of intracranial tuberculoma during anti-tuberculous therapy was reported. That may be due to hypersensitivity of tuberculoprotein, liberation from TB bacili after chemotherapy. If the patient's general condition satisfactory, an expanding CT abnormality dose not demand altemation chemotherapy.

並列關鍵字

Intracranial tuberculoma ； Anti-tuberculous therapy ； Tuberculosis