Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, China.
Qingdao Municipal Hospital, Qingdao, China.
World Neurosurg. 2018 Feb;110:73-78. doi: 10.1016/j.wneu.2017.10.128. Epub 2017 Oct 31.
Subarachnoid hemorrhage caused by rupture of tuberculosis associated aneurysm is a rare complication. In this paper, we report a case of intracranial tuberculum with adjacent intracerebral inflammatory aneurysm which caused subarachnoid hemorrhage and brain abscess formation.
A 28-year-old man presented with sudden onset of severe headache. He was diagnosed with pulmonary tuberculosis 8 years ago, and had been treated with antituberculosis medications for 6 months. Head computed tomography showed a small hematoma in the left sylvian fissure with subarachnoid hemorrhage. Cerebral digital subtraction angiography was performed and no aneurysm was found. He was discharged after nonsurgical treatment. Three weeks later, he came back to our department with complaint of aphasia. Magnetic resonance images showed a cystic lesion with mass effect. During operation, we encounter the brain abscess and were surprised to find a middle cerebral artery aneurysm while dissecting. The abscess was totally removed, and the aneurysm was secured by clipping. The aneurysm was suspected of being inflammatory in nature and associated with the patient's tuberculosis.
Tuberculosis in the central nervous system may present as tuberculoma and tuberculous meningitis. Vasculitis secondary to tuberculous meningitis can cause infarcts, and, rarely, aneurysm formation. This case report illustrated a rare case of intracranial infectious aneurysm related to tuberculosis and complicated by hemorrhage and brain abscess.
由结核相关动脉瘤破裂引起的蛛网膜下腔出血是一种罕见的并发症。本文报告了一例颅内结核伴邻近颅内炎症性动脉瘤引起蛛网膜下腔出血和脑脓肿形成的病例。
一名 28 岁男性突发严重头痛。他 8 年前被诊断患有肺结核，已接受抗结核药物治疗 6 个月。头部计算机断层扫描显示左侧大脑外侧裂有小血肿，伴有蛛网膜下腔出血。行脑数字减影血管造影术，未发现动脉瘤。经非手术治疗后出院。3 周后，他因言语障碍回到我科。磁共振成像显示有囊性病变伴占位效应。术中我们遇到脑脓肿，在解剖时惊讶地发现大脑中动脉动脉瘤。脓肿被完全清除，动脉瘤通过夹闭固定。该动脉瘤疑似炎症性，与患者的肺结核有关。
中枢神经系统的结核可表现为结核瘤和结核性脑膜炎。结核性脑膜炎引起的血管炎可导致梗死，很少引起动脉瘤形成。本病例报告说明了一例罕见的与结核有关的颅内感染性动脉瘤，并发出血和脑脓肿。
