Kumar R, Jain R, Kaur A, Chhabra D K
Department of Neuro-surgery, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow, India.
Br J Neurosurg. 2000 Aug;14(4):356-61. doi: 10.1080/026886900417397.
Tubercular meningitis and intracranial tuberculomas are the two frequent manifestations of neurotuberculosis with their variable incidence in different countries. Brain stem tuberculomas are even more unusual, accounting for 2.5-8% of all intracranial tuberculomas. We present here six paediatric cases of brain stem tuberculosis, where well-formed tuberculomas were demonstrated in five symptomatic cases; however, only a hypodense ill-defined lesion was found in the brain stem of one child who presented with features of tubercular meningitis. Three of these children had other associated tuberculomas in their brain parenchyma as well. All the six cases, however, showed the involvement of 3rd, 6th & 7th cranial nerves, in various combinations, at the time of initial presentation. Only two children developed hydrocephalus and required CSF diversion. All responded well to anti-tubercular chemotherapy, though two children developed toxicity to the therapy, which recovered with drug manipulation for about 2 months. Recovery was full without residual deficit in all the cases. Surgical excision of brain stem granulomas was not indicated in any case.
结核性脑膜炎和颅内结核瘤是神经结核的两种常见表现形式，在不同国家其发病率有所不同。脑干结核瘤更为罕见，占所有颅内结核瘤的2.5% - 8%。我们在此介绍6例小儿脑干结核病例，其中5例有症状的病例显示有完整的结核瘤；然而，在1例表现为结核性脑膜炎特征的患儿脑干中仅发现一个低密度、边界不清的病灶。这些患儿中有3例脑实质内还伴有其他结核瘤。然而，所有6例在初次就诊时均显示出不同组合的第3、6和7对脑神经受累。只有2例患儿出现脑积水并需要进行脑脊液分流。所有患儿对抗结核化疗反应良好，尽管有2例患儿出现治疗毒性反应，经调整药物约2个月后恢复。所有病例均完全康复，无残留神经功能缺损。所有病例均未行脑干肉芽肿手术切除。
