Nozaki H, Takashima S, Ishihara T, Aoyagi T
Department of Internal Medicine, National Higashisaitama Hospital.
Rinsho Shinkeigaku. 1992 Jan;32(1):91-3.
A 45-year-old female patient was admitted to a hospital because of tuberculous meningitis in July, 1986. She was treated with chemotherapy (oral isoniazid, rifampicin, ethambutol and an intramuscular injection of streptomycin). Her consciousness was worsened at first, but later she improved aside from some disabilities (incontinence, gait disturbance, disorientation and dementia). She was transferred to National Higashisaitama Hospital in November, 1986. Since then we have continued the chemotherapy, and she has improved gradually. Initially her cranial computerized tomography (CT) revealed no intracranial tuberculoma and showed mild enhancement of basal cistern. About 4 months later, her CT showed many tuberculomas with ringed or nodular enhancement. About 13 months later almost all tuberculomas disappeared. But a few were found with homogeneous enhancement and were enlarged in spite of adequate chemotherapy. These tuberculomas were enlarged while the chemotherapy was continued, but later they were reduced in size. About 3 and a half years later, these tuberculomas disappeared without any calcifications. The above facts may suggest that intracranial tuberculoma could appear and be enlarged on cranial CT in spite of adequate chemotherapy during a course of tuberculous meningitis. They also suggest that continuation of adequate chemotherapy might improve tuberculomas.
1986年7月，一名45岁女性患者因结核性脑膜炎入院。她接受了化疗（口服异烟肼、利福平、乙胺丁醇，并肌肉注射链霉素）。起初她的意识恶化，但后来除了一些残疾（大小便失禁、步态障碍、定向障碍和痴呆）外有所改善。1986年11月她被转至埼玉县东医院。从那时起我们继续进行化疗，她逐渐好转。最初她的头颅计算机断层扫描（CT）未显示颅内结核瘤，仅显示基底池轻度强化。大约4个月后，她的CT显示有许多结核瘤，呈环状或结节状强化。大约13个月后，几乎所有结核瘤都消失了。但发现有少数结核瘤呈均匀强化，尽管化疗充分仍在增大。这些结核瘤在继续化疗时增大，但后来体积缩小。大约3年半后，这些结核瘤消失且无任何钙化。上述事实可能表明，在结核性脑膜炎病程中，尽管化疗充分，颅内结核瘤仍可能在头颅CT上出现并增大。它们还表明，持续进行充分化疗可能会使结核瘤好转。
