Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Alucinaciones/etiología , Lóbulo Parietal , Lóbulo Temporal , Tuberculoma Intracraneal/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico por imagen , Infecciones Oportunistas Relacionadas con el SIDA/psicología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuroimagen , Lóbulo Parietal/diagnóstico por imagen , Lóbulo Parietal/patología , Lóbulo Temporal/diagnóstico por imagen , Lóbulo Temporal/patología , Tuberculoma Intracraneal/diagnóstico por imagen , Tuberculoma Intracraneal/etiología , Tuberculoma Intracraneal/psicologíaRESUMEN
BACKGROUND: Brain tuberculoma is a rare manifestation of tuberculosis especially in immunosuppressed patients. The definitive diagnosis may be difficult owing to mimicking brain tumors and the absence of the common presentation. Bacille Calmette-Guérin (BCG) vaccine is used for protection against tuberculous meningitis and miliary disease, more so in children, and also for the treatment of bladder cancer. CASE DESCRIPTION: The following case of brain tuberculoma is a boy aged 6 months who was presented to our hospital with poor feeding, nausea and vomiting, and confusion lasting 1 month. A brain magnetic resonance imaging scan showed a large mass lesion in the pineal region with generalized hydrocephaly in which polymerase chain reaction assays of the tissue was positive for Mycobacterium bovis and had a good response to antituberculosis drugs and surgery. CONCLUSIONS: We present a case of brain tuberculoma as the complication of BCG vaccine. To our knowledge, this case is the first case of brain tuberculoma after BCG vaccination. We should consider brain tuberculoma that presents with a similar presentation in any infants with a history of BCG vaccination.
Asunto(s)
Antituberculosos/uso terapéutico , Vacuna BCG/efectos adversos , Infecciones por Mycobacterium/etiología , Glándula Pineal/diagnóstico por imagen , Tuberculoma Intracraneal/etiología , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Infecciones por Mycobacterium/diagnóstico por imagen , Infecciones por Mycobacterium/tratamiento farmacológico , Mycobacterium bovis , Resultado del Tratamiento , Tuberculoma Intracraneal/diagnóstico por imagen , Tuberculoma Intracraneal/tratamiento farmacológicoRESUMEN
BACKGROUND: Cerebrovascular complications of tuberculous meningitis (TBM) are associated with increased morbidity and mortality. We retrospectively reviewed clinicoradiological findings of 90 TBM patients who presented to a tertiary care hospital, with emphasis on frequency and distribution of infarcts on diffusion imaging and pattern of vascular involvement on magnetic resonance (MR) angiography (MRA). MATERIALS AND METHODS: MR images of 90 TBM patients at presentation (2012-2018) were coanalyzed by two radiologists for tuberculomas, leptomeningeal enhancement (LM), hydrocephalus, infarct and vascular abnormalities. Infarcts were categorized based on location ("tubercular" (TB) or "ischemic" zones) and arterial supply (perforators and cortical branches). Clinical and laboratory findings were correlated with imaging data. RESULTS: Ninety TBM patients (age 10-82 years) were enlisted after application of inclusion criteria. Tuberculomas were most common (100%) followed by LM (84.4%), cerebral infarcts (57.7%) and hydrocephalus (29%). Location-wise, 35% infarcts were in ischemic, 13% in TB and 15% in both zones. According to arterial supply, infarcts equally (50%) involved perforators from the lateral lenticulostriate and posterior cerebral (PCA)/basilar artery (BA) followed by medial lenticulostriate arteries (23%). MRA was available in 74.4% and abnormal in 43.2%. The middle cerebral artery was frequently involved (76%) followed by the anterior cerebral artery (38%), internal carotid artery (31%), PCA and BA. Six had diffuse narrowing with a paucity of distal vessels. Cerebral infarction was associated with hydrocephalus (p = .0019) and vasculitis (p < .001). CONCLUSION: In TBM, strokes are common and mainly involve the perforators and cortical branches. MR is the imaging modality of choice for early diagnosis and timely management.
Asunto(s)
Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/patología , Tuberculosis Meníngea/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Imagen de Difusión por Resonancia Magnética/métodos , Femenino , Humanos , Hidrocefalia/diagnóstico por imagen , Hidrocefalia/etiología , Hidrocefalia/patología , Angiografía por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Centros de Atención Terciaria , Tuberculoma Intracraneal/diagnóstico por imagen , Tuberculoma Intracraneal/etiología , Tuberculoma Intracraneal/patología , Tuberculosis Meníngea/patología , Adulto JovenRESUMEN
BACKGROUND AND PURPOSE: There is a paucity of literature related to the neuroimaging of CNS tuberculosis (TB) and largely covers pediatric CNS TB. The objective of this study was to determine the frequency of different forms of CNS TB and its associated complications and to study longitudinal disease course using computed tomography (CT) and MRI. METHODS: Retrospective chart and imaging review of patients diagnosed with CNS TB in a tertiary care hospital in Pakistan over a 10-year period. A total of 452 initial brain MRI and 209 CT scans were reviewed by an expert radiologist specialized in neuroimaging. This was followed by review of 53 MRI/52 CT and 7 MRI/14 CT first and second follow-up scans, respectively. RESULTS: Note that 559 patients, 296 males and 263 females were included in the study. On the initial CT scans, tuberculomas were found in 25 (12%), infarction in 54 (25%), basal meningeal enhancement in 29 (14%), and hydrocephalus in 84 (40%). On initial MRI, tuberculomas were found in 182 (40%), infarction in 120 (27%), basal meningeal enhancement in 184 (41%), and hydrocephalus in 116 (26%). On review of follow-up CT scans, 13 (25%) showed new or worsening hydrocephalus, 8 (15%) showed new infarcts, 1 exhibited new tuberculoma, and 5 showed worsening cerebral edema. On review of follow-up MRI scans, new or worsening hydrocephalus was seen in 3 (6%), new infarcts in 3 (6%), new tuberculoma in 10 (19%), worsening cerebral edema in 7 (13%), and TB myelitis in 4 (8%) patients. CONCLUSIONS: Tuberculoma, hydrocephalus, and cerebral infarcts are the most prominent findings in CNS tuberculosis. Our study showed development of new lesions on subsequent neuroimaging suggesting a dynamic and progressive nature of the disease process in some individuals.
Asunto(s)
Encéfalo/diagnóstico por imagen , Infarto Cerebral/diagnóstico por imagen , Hidrocefalia/diagnóstico por imagen , Neuroimagen , Tuberculoma Intracraneal/diagnóstico por imagen , Tuberculosis del Sistema Nervioso Central/diagnóstico por imagen , Infarto Cerebral/etiología , Niño , Preescolar , Progresión de la Enfermedad , Femenino , Humanos , Hidrocefalia/etiología , Imagen por Resonancia Magnética , Masculino , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Tuberculoma Intracraneal/etiología , Tuberculosis del Sistema Nervioso Central/complicacionesRESUMEN
PURPOSE: As a result of multilateral migration and globalization in times of humanitarian crises, western countries face a possible increase in the incidence of central nervous system tuberculosis (CNS TB). The diagnosis of CNS TB is challenging and often delayed due to the manifold and often non-specific presentation of the disease. The aim of this review is to analyze and summarize imaging features and correlated clinical findings of CNS TB. METHODS: The different manifestations of CNS TB are explained and illustrated by characteristic neuroradiological as well as neuropathological findings. An overview on diagnostic and therapeutic approaches is provided. For clarity, tables summarizing the lesion patterns, differential diagnoses and diagnostic hints are added. RESULTS: The CNS TB can be manifested (1) diffuse as tuberculous meningitis (TBM), (2) localized as tuberculoma or (3) tuberculous abscess or (4) in extradural and intradural spinal infections. Information on clinical presentation, underlying pathology and the distinguishing features is demonstrated. The TBM is further described, which may lead to cranial nerve palsy, hydrocephalus and infarction due to associated arteritis of the basal perforators. The differential diagnoses are vast and include other infections, such as bacterial, viral or fungal meningoencephalitis, malignant causes or systemic inflammation with CNS. Complicating factors of diagnosis and treatment are HIV coinfection, multi-drug resistance and TB-associated immune reconstitution inflammatory syndrome (IRIS). CONCLUSIONS: Neurologists and (neuro-)radiologists should be familiar with the neuroradiological presentation and the clinical course of CNS TB to ensure timely diagnosis and treatment.
Asunto(s)
Tuberculosis del Sistema Nervioso Central/complicaciones , Tuberculosis del Sistema Nervioso Central/diagnóstico , Antituberculosos/uso terapéutico , Diagnóstico Diferencial , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Humanos , Síndrome Inflamatorio de Reconstitución Inmune/diagnóstico , Imagen por Resonancia Magnética , Masculino , Meningoencefalitis/diagnóstico por imagen , Meningoencefalitis/etiología , Mycobacterium tuberculosis/aislamiento & purificación , Neuroimagen , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Enfermedades de la Columna Vertebral/etiología , Tomografía Computarizada por Rayos X , Tuberculoma/diagnóstico por imagen , Tuberculoma/etiología , Tuberculoma Intracraneal/diagnóstico por imagen , Tuberculoma Intracraneal/etiología , Tuberculosis del Sistema Nervioso Central/líquido cefalorraquídeo , Tuberculosis del Sistema Nervioso Central/tratamiento farmacológico , Tuberculosis Meníngea/líquido cefalorraquídeo , Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/tratamiento farmacológico , Tuberculosis Meníngea/etiología , Tuberculosis Resistente a Múltiples Medicamentos , Tuberculosis Osteoarticular/diagnóstico por imagen , Tuberculosis Osteoarticular/etiologíaAsunto(s)
Infecciones por VIH/diagnóstico por imagen , Tuberculoma Intracraneal/diagnóstico por imagen , Adulto , Biopsia , Encéfalo/diagnóstico por imagen , Encefalopatías/diagnóstico por imagen , Femenino , Infecciones por VIH/complicaciones , Humanos , Imagen por Resonancia Magnética , Necrosis , Tomografía Computarizada por Rayos X , Tuberculoma Intracraneal/etiologíaRESUMEN
Primary inoculation tuberculosis is a skin condition that develops at the site of inoculation of Mycobacterium tuberculosis in tuberculosis-free individuals. This report describes the diagnosis, treatment and >1 year follow-up of 30 patients presenting with acupuncture-induced primary inoculation tuberculosis. Our data provide a deeper insight into this rare route of infection of tuberculosis. We also review effective treatment options.
Asunto(s)
Terapia por Acupuntura/efectos adversos , Tuberculosis/diagnóstico , Tuberculosis/etiología , Adulto , Anciano , Antituberculosos/uso terapéutico , Encéfalo/patología , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Articulación de la Rodilla/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Piel/patología , Resultado del Tratamiento , Tuberculoma Intracraneal/diagnóstico , Tuberculoma Intracraneal/etiología , Tuberculosis/tratamiento farmacológico , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/etiología , Tuberculosis Osteoarticular/diagnóstico , Tuberculosis Osteoarticular/etiología , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/etiologíaRESUMEN
BACKGROUND: Tuberculoma and cerebral infarctions are serious complications of central nervous system (CNS) tuberculosis. However, there are no studies comparing prognostic value of tuberculoma and infarcts alone and in patients diagnosed with CNS tuberculosis. OBJECTIVE: The objective of this study was to identify frequency and prognostic value of tuberculoma and cerebral infarcts in a large sample of CNS tuberculosis patients. METHODS: Retrospective chart review of patients diagnosed with CNS tuberculosis in a tertiary care hospital in Pakistan over 10-year period was carried out. RESULTS: There were 404 patients included in this study (mean age of 43 years). There were 209 (52%) men and 195 (48%) women. Tuberculoma were present in 202 subjects (50%) while infarcts were present in 25% patients. 147 (36%) had tuberculous meningitis (TBM) without tuberculoma or infarction on CT or MRI, 158 (39%) had TBM with intracranial tuberculomas, 60 (15%) had TBM with cerebral infarction while 39 (10%) had TBM with both tuberculoma and infarction. At discharge, 249 patients (62%) were either normal (Modified Rankin Score (MRS)=0) or mild to moderately disabled (MRS=1-3) while 82 patients (20%) had severe disability (MRS=4-5). 73 (18%) patients died (MRS=6) during hospitalisation. Using logistic regression analysis, significant predictors of poor outcome included old age, high TBM grading, presence of infarction and presence of hydrocephalus. CONCLUSIONS: Tuberculomas were present in 50% of patients, while infarcts were present in 25%. Old age, TBM grading, presence of infarction and hydrocephalus were all predictors of poor outcome.
Asunto(s)
Infarto Cerebral/etiología , Tuberculoma Intracraneal/etiología , Tuberculosis del Sistema Nervioso Central/complicaciones , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Infarto Cerebral/diagnóstico , Infarto Cerebral/microbiología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pakistán/epidemiología , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos X , Tuberculoma Intracraneal/diagnóstico , Tuberculosis del Sistema Nervioso Central/diagnóstico , Tuberculosis Meníngea/complicaciones , Adulto JovenRESUMEN
Tumor necrosis factor α antagonist therapies represent an increased risk of reactivation of tuberculosis. We report two cases of life-threatening disseminated tuberculosis in patients undergoing treatment with infliximab for Crohn's disease including one case of a patient with cerebral tuberculomas. We discuss the implication of tumor necrosis factor α in the genesis of tuberculosis infection and the features of tuberculosis under infliximab. Tuberculosis screening and eventually preventive chemotherapy should become the standard of care for individual undergoing tumor necrosis factor α antagonist therapies.
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Antiinflamatorios no Esteroideos/efectos adversos , Anticuerpos Monoclonales/efectos adversos , Encefalopatías/etiología , Enfermedad de Crohn/tratamiento farmacológico , Tuberculoma/etiología , Tuberculosis Miliar/etiología , Adulto , Encefalopatías/tratamiento farmacológico , Cerebro , Enfermedad de Crohn/complicaciones , Humanos , Infliximab , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis , Recurrencia , Tuberculoma/tratamiento farmacológico , Tuberculoma Intracraneal/tratamiento farmacológico , Tuberculoma Intracraneal/etiología , Tuberculosis Miliar/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresAsunto(s)
Errores Diagnósticos/prevención & control , Lupus Eritematoso Sistémico , Prednisolona , Tuberculosis del Sistema Nervioso Central , Adulto , Antituberculosos/administración & dosificación , Diagnóstico Diferencial , Humanos , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Imagen por Resonancia Magnética/métodos , Masculino , Prednisolona/administración & dosificación , Prednisolona/efectos adversos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Tuberculoma Intracraneal/diagnóstico , Tuberculoma Intracraneal/tratamiento farmacológico , Tuberculoma Intracraneal/etiología , Tuberculoma Intracraneal/fisiopatología , Tuberculosis del Sistema Nervioso Central/diagnóstico , Tuberculosis del Sistema Nervioso Central/tratamiento farmacológico , Tuberculosis del Sistema Nervioso Central/etiología , Tuberculosis del Sistema Nervioso Central/fisiopatología , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/etiología , Tuberculosis Pulmonar/fisiopatologíaRESUMEN
Partial seizures can be due to a growing cerebral lesion, which may be tumoral or inflammatory/infectious in nature. The differential diagnosis is obviously important; increasing immigration to Europe from Africa is leading to an increase of infectious disease involving also the central nervous system. The authors report imaging the a case of a brain tuberculoma due to Mycobacterium africanum mimicking brain tumor, in which diagnosis was possible by inoculum in guinea-pig of material obtained by mediastinal biopsy of enlarged lymph nodes. Specific treatment led to marked reduction in the size of the brain lesion.
Asunto(s)
Infecciones por Mycobacterium/complicaciones , Tuberculoma Intracraneal/diagnóstico , Tuberculoma Intracraneal/etiología , Adulto , Antituberculosos/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Masculino , Infecciones por Mycobacterium/tratamiento farmacológico , Radiografía Torácica , Tuberculoma Intracraneal/tratamiento farmacológicoAsunto(s)
Trasplante de Riñón , Complicaciones Posoperatorias/diagnóstico , Tuberculoma Intracraneal/diagnóstico , Tuberculosis Laríngea/diagnóstico , Adulto , Anciano , Antituberculosos/uso terapéutico , Cerebelo/microbiología , Cerebelo/patología , Femenino , Lóbulo Frontal/microbiología , Lóbulo Frontal/patología , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Tuberculosis Latente/diagnóstico , Masculino , Lóbulo Occipital/microbiología , Lóbulo Occipital/patología , Riñón Poliquístico Autosómico Recesivo/cirugía , Tuberculoma Intracraneal/etiología , Tuberculosis Laríngea/etiología , Tuberculosis Pulmonar/complicacionesAsunto(s)
Antituberculosos/uso terapéutico , Tuberculoma Intracraneal/etiología , Tuberculoma Intracraneal/patología , Tuberculosis Renal/tratamiento farmacológico , Anciano , Dexametasona/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Masculino , Esteroides/uso terapéutico , Resultado del Tratamiento , Tuberculoma Intracraneal/tratamiento farmacológicoRESUMEN
BACKGROUND: Vision impairment is a devastating complication of tuberculous meningitis. In the present study we evaluated the predictors and prognostic significance of vision impairment in tuberculous meningitis. METHODS: In this study, 101 adult patients with tuberculous meningitis were evaluated for vision status and physical disability and were followed up for 6 months. Contrast enhanced magnetic resonance imaging (MRI) was performed at baseline and 6 months. RESULT: Out of 101 patients, 74 patients had normal vision and 27 patients had low vision or blindness at enrollment. Thirteen patients died during the study period. Out of 88 patients who survived at 6 months, 68 patients had good vision, 11 patients had low vision and 9 patients had blindness. Predictors of vision deterioration were papilledema, cranial nerve palsies, raised cerebrospinal fluid protein (>1g/L), and presence of optochiasmatic arachnoiditis in MRI. Predictors of blindness, at 6 months, were found to be papilledema, vision acuity < or =6/18, cranial nerve palsies, tuberculous meningitis stage II or III, raised cerebrospinal fluid protein (>1g/L), optochiasmatic arachnoiditis, and optochiasmal tuberculoma. At 6 months, 27 patients had death or severe disability. Predictors of death or severe disability at 6 months were vision acuity < or =6/18, cranial nerve deficits, hemiparesis, clinical stage II or III, and presence of infarct in MRI. CONCLUSION: Vision impairment occurred in one-fourth of patients with tuberculous meningitis. Principal causes of vision loss were optochiasmatic arachnoiditis and optochiasmal tuberculoma. Impaired vision predicted death or severe disability.
Asunto(s)
Tuberculosis Meníngea/complicaciones , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/etiología , Adulto , Aracnoides/patología , Aracnoides/fisiopatología , Encéfalo/patología , Encéfalo/fisiopatología , Proteínas del Líquido Cefalorraquídeo/análisis , Proteínas del Líquido Cefalorraquídeo/metabolismo , Enfermedades de los Nervios Craneales/diagnóstico , Enfermedades de los Nervios Craneales/etiología , Enfermedades de los Nervios Craneales/fisiopatología , Técnicas de Diagnóstico Oftalmológico , Evaluación de la Discapacidad , Progresión de la Enfermedad , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Examen Neurológico , Trastornos de la Motilidad Ocular/diagnóstico , Trastornos de la Motilidad Ocular/etiología , Trastornos de la Motilidad Ocular/fisiopatología , Quiasma Óptico/patología , Quiasma Óptico/fisiopatología , Nervio Óptico/patología , Nervio Óptico/fisiopatología , Papiledema/diagnóstico , Papiledema/etiología , Papiledema/fisiopatología , Valor Predictivo de las Pruebas , Pronóstico , Índice de Severidad de la Enfermedad , Tuberculoma Intracraneal/etiología , Tuberculoma Intracraneal/patología , Tuberculoma Intracraneal/fisiopatología , Trastornos de la Visión/fisiopatología , Pruebas de Visión , Adulto JovenAsunto(s)
Quiasma Óptico/patología , Enfermedades del Nervio Óptico/etiología , Complicaciones Infecciosas del Embarazo , Tuberculoma Intracraneal/etiología , Tuberculosis Meníngea/complicaciones , Adolescente , Antituberculosos/uso terapéutico , Líquido Cefalorraquídeo/microbiología , ADN Bacteriano/análisis , Quimioterapia Combinada , Femenino , Edad Gestacional , Humanos , Imagen por Resonancia Magnética , Mycobacterium tuberculosis/aislamiento & purificación , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/tratamiento farmacológico , Embarazo , Tuberculoma Intracraneal/diagnóstico , Tuberculoma Intracraneal/tratamiento farmacológico , Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/tratamiento farmacológico , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/tratamiento farmacológico , Trastornos de la Visión/etiologíaAsunto(s)
Calcinosis/etiología , Tuberculoma Intracraneal/etiología , Tuberculosis Meníngea/complicaciones , Progresión de la Enfermedad , Femenino , Lóbulo Frontal/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética/métodos , Bulbo Raquídeo/diagnóstico por imagen , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodos , Tuberculoma Intracraneal/diagnóstico por imagen , Tuberculosis Meníngea/diagnóstico por imagenRESUMEN
HIV infection is a major risk factor for tuberculosis. We describe the case of a 30-year-old male presenting with headache, compromised mental status, seizures, neck stiffness and fever that was subsequently diagnosed with HlV and neuroinfection. Clinical data, cerebrospinal fluid and brain imaging supported a diagnosis of neurotuberculosis. Cranial magnetic resonance imaging showed diffuse arachnoidal enhancement, mainly at the basal cisterns and cortical encephalitis. Such imaging findings play a key role in the diagnosis of central nervous system tuberculosis.
Asunto(s)
Aracnoiditis/etiología , Encefalitis/etiología , Seropositividad para VIH/complicaciones , Tuberculoma Intracraneal/etiología , Adulto , Humanos , MasculinoRESUMEN
La infección por VIH es uno de los mayores factores de riesgo para tuberculosis. Presentamos el caso de un paciente de 30 años que ingresó al hospital con datos neurológicos caracterizados por cefalea, alteración del alerta, crisis convulsivas, signos meníngeos y fiebre, a quien subsecuentemente se le diagnosticó VIH y neuroinfección. Los datos clínicos, el examen del líquido cefalorraquídeo y la neuroimagen sustentaron el diagnóstico de neurotuberculosis. La resonancia magnética de cráneo reveló aracnoiditis generalizada de predominio basal, así como encefalitis cortical. Los hallazgos de imagen desempeñan un papel fundamental en el diagnóstico integral de la tuberculosis del sistema nervioso central.
HIV infection is a major risk factor for tuberculosis. We describe the case of a 30-year-old male presenting with headache, compromised mental status, seizures, neck stiffness and fever that was subsequently diagnosed with HlV and neuroinfection. Clinical data, cerebrospinal fluid and brain imaging supported a diagnosis of neurotuberculosis. Cranial magnetic resonance imaging showed diffuse arachnoidal enhancement, mainly at the basal cisterns and cortical encephalitis. Such imaging findings play a key role in the diagnosis of central nervous system tuberculosis.
Asunto(s)
Humanos , Masculino , Adulto , Aracnoiditis/etiología , Encefalitis/etiología , Seropositividad para VIH/complicaciones , Tuberculoma Intracraneal/etiologíaRESUMEN
Tumor de Pott (Potts Puffy tumor) é uma comorbidade caracterizada por um ou mais abscessos sub-periosteais do osso frontal associados a osteomielite subjacente. As etiologias incluem trauma e sinusite, entre outras. Relatamos o caso de uma paciente de 17 anos que se apresentou com abaulameto doloroso, calor local e flutuação na região frontal à direita há um mês, bem como cefaléia holocraniana e hipertermia. O diagnóstico de Tumor de Pott como uma complicação de uma sinusite frontal foi estabelecido pela clínica e confirmado por tomografia computadorizada de crânio. Foi tratada com sucesso com esquema inicial de amoxicilina mais clavulanato, o qual foi substituído por ciprofloxacina, associados à craniotomia, com craniectomia do osso acometido. Esta é uma doença que por ser infreqüente muitas vezes não é diagnosticada. Deste modo enfatizamos o diagnóstico e tratamento precoces como forma de evitar seqüelas neurológicas.
Potts Puffy Tumor is a comorbidity characterized by one or multiple subperiosteal abscesses of the frontal bone associated with underlying osteomyelitis. Etiologies include trauma and sinusitis among others. Here we report the case of a 17-year-old female patient with painful bulging, local heat, and fluctuation in the frontal region on the right for a month, as well as holocranial headache and hyperthermia. The diagnosis of Potts Puffy Tumor as a complication of frontal sinusitis was clinically established and confirmed by computerized tomography of the skull. It was successfully initially treated with amoxicilin + clavunate, followed by ciprofloxacin, combined with craniotomy and craniectomy of the affected bone. Because of its rarity, this disorder often goes underdiagnosed. Thus we emphasize an early diagnosis and treatment so as to avoid neurological sequels.