Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
J Microbiol Immunol Infect. 2010 Jun;43(3):249-52. doi: 10.1016/S1684-1182(10)60039-4.
The case of a child admitted to hospital with acute onset of hemiparesis and seizure is presented. Extensive evaluation of an acute ischemic event in the form of a brain infarct found on brain magnetic resonance imaging was inconclusive. Two months later, the patient was referred with severe hydrocephalus, which was managed with ventriculoperitoneal shunting in the presence of normal ventricular cerebrospinal fluid. The shunt was complicated by distal end infection. During the insertion of a second shunt, and after 3 months of antibiotic therapy, peritoneal thickening was found. Peritoneal biopsy showed evidence of a granulomatous reaction. This finding, along with positive polymerase chain reaction of the cerebrospinal fluid, confirmed tuberculosis. The patient recovered from most of his symptoms after antituberculous therapy, and a new ventriculoperitoneal shunt was inserted. This is a very peculiar presentation of tuberculosis that began with a cerebral infarction due to vasculopathy and hydrocephalus without any constitutional symptoms, and was later confirmed by peritoneal pathology.
现介绍一例因急性偏瘫和癫痫发作而入院的儿童病例。广泛评估提示脑梗死形式的急性缺血性事件，但脑磁共振成像检查结果不确定。两个月后，患者因严重脑积水就诊，脑室-腹腔分流术在正常脑室脑脊液的情况下进行。分流器出现远端感染并发症。在插入第二个分流器时，经过 3 个月的抗生素治疗后，发现腹膜增厚。腹膜活检显示存在肉芽肿反应。这一发现，以及脑脊液聚合酶链反应阳性，证实了结核病。患者在抗结核治疗后大部分症状得到缓解，并插入了新的脑室-腹腔分流器。这是一种非常特殊的结核病表现，最初表现为血管病引起的脑梗死和脑积水，没有任何全身症状，后来通过腹膜病理学得到证实。
