Intracranial Tuberculoma Manifesting as Progressive Limb Weakness

引起結核病的結核桿菌通常感染到肺部，另外有三分之一的病例會侵犯到其他器官。肺外受侵犯的部位為淋巴結、胸膜、腸胃道、骨頭及關節、腦膜及腹膜。而肺外受到感染的病例中大約有5%會侵犯到中樞神經系統。受到感染的多為小孩或是免疫機能不全的病人。而結核瘤是結核病中不常見的一種類型，通常以一個或是多個佔據空間的病徵來表現，伴隨有癲癇或是局部神經學症狀。本文報告一位37歲的男性，伴隨有酗酒及肝硬化的過去病史，開始以手部動作不靈活及漸進式右側肢體無力為臨床表現。影像學檢查疑似腦部腫瘤(brain tumor)。在接受過手術清除腫瘤及病理切片報告證實為肺結核所引起的顱內結核瘤(intracranial tuberculoma)，同時開始給予抗結核藥物。另外在胸部X光片追蹤也發現有肺部結核的表現。在服藥六個月之後再追蹤腦部核磁共振並無再復發之跡象。透過此罕見病例，當面對免疫機能不全病人伴有漸進式肢體偏癱同時影像學檢查上有發現時，需要盡一步的追蹤胸部X光檢查並將顱內結核瘤的診斷謹記於心。

關鍵字

腦部腫瘤；偏癱；顱內結核瘤

並列摘要

A 37-year-old man presented with a progressive right limbs weakness with numbness for 1 month. Brain computed tomography scans revealed a lesion with peripheral swelling in the left thalamus. A craniotomy for evacuation of the brain tumor was performed, and an intracranial tuberculoma was made based on pathological result. The patient's neurological deficits were reversed with surgical intervention. No definite evidence of residual or recurrent foci was noted on brain magnetic resonance imaging after a six-month course of antituberculosis medication. This is an uncommon manifestation of tuberculosis infection in the central nervous system in Taiwan. This case gives the neurosurgeon the suspicion of a rare presentation of space-occupying lesion causing hemiplegia in the patient.

並列關鍵字

brain tumor ； hemiplegia ； intracranial tuberculoma

國際替代計量

Intracranial Tuberculoma Manifesting as Progressive Limb Weakness

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