Kubota A, Takahashi T, Suzuki Y, Hasegawa O
Department of Neurology, Yokohama City University School of Medicine.
Rinsho Shinkeigaku. 1992 Aug;32(8):849-52.
A 54-year-old woman developed headache and slight fever. When she consulted a physician, she could not move either of her eyes to the right. Cranial CT scan revealed no significant findings. Lumbar puncture was performed and CSF examination showed the cell count of 10,304/mm3, glucose level of 10 mg/dl, and total protein value of 270 mg/dl. Her symptoms and laboratory findings suggested meningitis and she was admitted to our hospital. Neurological examination revealed bilateral dilated pupils with sluggish light reflex, right gaze palsy, and hypesthesia of the left side of her face. A diagnosis of tuberculous meningitis was established by a positive test for acid-fast bacillus in CSF, and anti-tuberculous therapy was started at once. One month after the onset of symptoms, her main complaints were double vision and cerebellar ataxia. Both CT and MRI revealed a right brain-stem lesion. Pre-contrast CT could not clearly visualize the lesion but with contrast medium a homogeneously-enhanced circular lesion was shown. MRI on T2WI demonstrated the right brain-stem lesion to have a central bright core with hypointense periphery, which in turn was surrounded by hyperintensity. The lesion appeared isointense with cerebral white matter and the "central bright core" area was demonstrated to be slightly hypointense on T1WI. On post-contrast T1WI (with Gd-DTPA), the lesion showed strong homogeneous enhancement. The CT and MRI findings indicated a brain-stem tuberculoma, which was regarded as the cause of the ocular movement paralysis and cerebellar ataxia. As the clinical symptoms gradually resolved with anti-tuberculous treatment, the MRI appearance of the lesion also improved.(ABSTRACT TRUNCATED AT 250 WORDS)
一名54岁女性出现头痛和低热。她就医时,双眼均无法向右转动。头颅CT扫描未发现明显异常。进行了腰椎穿刺,脑脊液检查显示细胞计数为10304/mm³,葡萄糖水平为10mg/dl,总蛋白值为270mg/dl。她的症状和实验室检查结果提示为脑膜炎,遂入住我院。神经系统检查发现双侧瞳孔散大,对光反射迟钝,右眼凝视麻痹,左侧面部感觉减退。脑脊液抗酸杆菌检测呈阳性,确诊为结核性脑膜炎,立即开始抗结核治疗。症状出现1个月后,她的主要主诉为复视和小脑性共济失调。CT和MRI均显示右侧脑干有病变。平扫CT无法清晰显示病变,但增强扫描可见一个均匀强化的圆形病变。MRI的T2WI序列显示右侧脑干病变中央为高信号核心,周边为低信号,其外又被高信号环绕。该病变在T1WI序列上与脑白质信号等,“中央高信号核心”区域在T1WI上略呈低信号。增强T1WI(使用钆喷酸葡胺)序列上,病变呈明显均匀强化。CT和MRI表现提示为脑干结核瘤,被认为是眼球运动麻痹和小脑性共济失调的病因。随着抗结核治疗临床症状逐渐缓解,病变的MRI表现也有所改善。(摘要截选至250字)