Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779M, San Francisco, CA 94143-0112, USA.
J Clin Neurosci. 2013 Oct;20(10):1333-41. doi: 10.1016/j.jocn.2013.01.008. Epub 2013 Jun 12.
Tuberculosis is among the oldest and most devastating infectious diseases worldwide. Nearly one third of the world's population has active or latent disease, resulting in 1.5 million deaths annually. Central nervous system involvement, while rare, is the most severe form of tuberculosis. Manifestations include tuberculoma and tuberculous meningitis, with the majority of cases occurring in children and immunocompromised patients. Despite advancements in imaging and laboratory diagnostics, tuberculomas of the central nervous system remain a diagnostic challenge due to their insidious nature and nonspecific findings. On imaging studies tuberculous meningitis is characterized by diffuse basal enhancement, but tuberculomas may be indistinguishable from neoplasms. Early diagnosis is imperative, since clinical outcomes are largely dependent on timely treatment. Stereotactic biopsy with histopathological analysis can provide a definitive diagnosis, but is only recommended when non-invasive methods are inconclusive. Standard medical treatment includes rifampicin, isoniazid, pyrazinamide, and streptomycin or ethambutol. In cases of drug resistance, revision of the treatment regimen with second-line agents is recommended over the addition of a single drug to the first-line regimen. Advances in genomics have identified virulent strains of tuberculosis and are improving our understanding of host susceptibility. Neurosurgical referral is advised for patients with elevated intracranial pressure, seizures, or brain or spinal cord compression. This review synthesizes pertinent findings in the literature surrounding central nervous system tuberculoma in an effort to highlight recent advances in pathophysiology, diagnosis, and treatment.
结核病是全球最古老、最具破坏性的传染病之一。全世界近三分之一的人口患有活动性或潜伏性疾病，每年导致 150 万人死亡。中枢神经系统受累虽然罕见，但却是结核病最严重的形式。其表现包括结核瘤和结核性脑膜炎，大多数病例发生在儿童和免疫功能低下的患者中。尽管影像学和实验室诊断技术有所进步，但由于中枢神经系统结核瘤的隐匿性和非特异性表现，其诊断仍然具有挑战性。在影像学研究中，结核性脑膜炎的特征是弥漫性基底强化，但结核瘤可能与肿瘤无法区分。早期诊断至关重要，因为临床结果在很大程度上取决于及时治疗。立体定向活检结合组织病理学分析可以提供明确的诊断，但只有在非侵入性方法不确定时才推荐使用。标准的医疗治疗包括利福平、异烟肼、吡嗪酰胺和链霉素或乙胺丁醇。如果存在耐药性，建议在一线方案中添加一种药物之前，用二线药物修改治疗方案。基因组学的进步已经确定了具有毒力的结核菌株，并提高了我们对宿主易感性的理解。对于颅内压升高、癫痫发作或脑或脊髓压迫的患者，建议神经外科转诊。本综述综合了文献中有关中枢神经系统结核瘤的相关发现，旨在强调在发病机制、诊断和治疗方面的最新进展。
