Krygowski James D, Brennen Delon F P, Counselman Francis L
Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA.
J Emerg Med. 2010 Apr;38(3):323-7. doi: 10.1016/j.jemermed.2007.10.060. Epub 2008 Apr 24.
A 2-year-old boy was brought to the Emergency Department (ED) with a complaint of 3-week history of increasing lethargy, weight loss, intermittent low grade fever, and right-sided tremor. A non-contrast computed tomography (CT) scan of the head, ordered by the patient's pediatrician, was interpreted as abnormal and the patient was referred to the ED for further evaluation. Physical examination was remarkable for somnolence requiring tactile stimulation to arouse the patient. Neurologic examination revealed right-sided choreoathetosis and unsteady gait. A contrast CT scan of the head demonstrated multiple ring-enhancing lesions throughout the brain and mild to moderate third and lateral ventricular enlargement. In view of the positive purified protein derivative test, chest X-ray study, and gastric aspirates positive for tuberculosis, a diagnosis of intracranial tuberculomas was made. The epidemiology, clinical presentation, diagnostic evaluation, and management of intracranial tuberculomas are reviewed.
一名2岁男孩因出现3周来日益加重的嗜睡、体重减轻、间歇性低热及右侧震颤而被送往急诊科（ED）。患儿的儿科医生安排了头部非增强计算机断层扫描（CT），结果显示异常，于是该患儿被转至急诊科做进一步评估。体格检查发现患儿嗜睡，需通过触觉刺激才能唤醒。神经系统检查显示右侧舞蹈手足徐动症及步态不稳。头部增强CT扫描显示全脑有多个环形强化病灶，第三脑室和侧脑室有轻至中度扩大。鉴于结核菌素纯蛋白衍生物试验阳性、胸部X线检查及胃抽吸物结核杆菌检测呈阳性，诊断为颅内结核瘤。本文对颅内结核瘤的流行病学、临床表现、诊断评估及治疗进行了综述。
