Noriega L, Villarreal F
Departamento de Medicina Interna, Servicio de Neurología, Hospital Regional Doctor Rafael Hernández, David, Panama.
Rev Neurol. 2003;37(6):531-5.
The tuberculosis is a disease that continues being important cause of morbidity and mortality at worldwide level. Its presentation as tuberculomas cerebral manifold at level of the central nervous system is little frequent in immunocompetent patients and can be confused with other etiology.
An indigenous young man, immunocompetent consulted for history of headache, nausea, vomits, convulsions, double vision and hemiparesia left side, which in the cerebral tomography of revenue was showing injuries compatible with cerebral abscesses; for which he received treatment with antibiotics without improvement for what there takes biopsy of the injuries that reported tuberculomas, specific treatment being initiated later and the primary area being investigated without the same one be detecting. After the first procedural step with evident clinical and radiographic improvement.
The tuberculosis in anyone of their forms of presentation must be included within the diagnosis differential of the patients in our endemic countries for this disease. The clinical and radiological diagnosis of cerebral injuries is difficult and single usually it obtains to the diagnosis during a pathology study that shows tuberculomas with caseosa necrosis, epiteliodes cell and the acid alcohol bacilli resistant.
结核病仍是全球范围内发病和死亡的重要原因。在免疫功能正常的患者中，其在中枢神经系统表现为多发性脑结核瘤的情况并不常见，且可能与其他病因相混淆。
一名免疫功能正常的本土青年男子因头痛、恶心、呕吐、抽搐、复视和左侧偏瘫病史前来就诊，初次脑部断层扫描显示有与脑脓肿相符的损伤；为此他接受了抗生素治疗，但病情无改善，随后对损伤部位进行活检，结果报告为结核瘤，之后开始进行特异性治疗并对原发部位进行检查，但未检测到。经过第一步治疗后，临床和影像学有明显改善。
在我们国家，对于这种疾病，无论其以何种形式呈现，结核病都必须纳入患者的鉴别诊断中。脑损伤的临床和放射学诊断很困难，通常只有在病理研究中发现有干酪样坏死、上皮样细胞和抗酸酒精杆菌的结核瘤时才能确诊。
