Lee W Y, Pang K Y, Wong C K
Department of Neurosurgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong.
Hong Kong Med J. 2002 Feb;8(1):52-6.
We report two cases of brain tuberculoma occurring in patients residing in Hong Kong. Both patients presented with headache and had space-occupying lesions evident on computed tomography scans of the brain. The patients had no history of tuberculosis and no symptoms of concurrent extracranial tuberculosis were evident. The diagnosis of tuberculoma was made at the time of surgical excision. Delayed diagnosis of brain tuberculoma is likely to occur in industrialised countries where tuberculosis is rare. In Hong Kong, however, with a constant influx of foreign domestic workers from endemic regions, a high index of suspicion should be maintained. Imaging studies support, but do not confirm, the diagnosis of brain tuberculoma. We recommend obtaining a definitive histological diagnosis, with computed tomography-guided stereotactic biopsy, before starting antituberculous therapy. Surgical excision is necessary in patients with raised intracranial pressure secondary to the lesion, who are not responding to medical therapy.
我们报告了两例发生在居住于香港的患者身上的脑结核瘤病例。两名患者均出现头痛症状，脑部计算机断层扫描显示有占位性病变。患者既往无结核病病史，也无明显的并发颅外结核症状。脑结核瘤的诊断是在手术切除时确定的。在结核病罕见的工业化国家，脑结核瘤可能会出现诊断延迟的情况。然而，在香港，由于不断有来自结核病流行地区的外籍家庭佣工涌入，应保持高度的怀疑指数。影像学研究有助于支持但不能确诊脑结核瘤。我们建议在开始抗结核治疗之前，通过计算机断层扫描引导下的立体定向活检获得明确的组织学诊断。对于因病变导致颅内压升高且药物治疗无效的患者，手术切除是必要的。
