Abdolhoseinpour Hesam, Abolghasemi Soheila, Jangholi Ehsan, Naghi Tehrani Khadijeh Haji
Department of Neurosurgery, Bou Ali Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran.
Department of Infectious Diseases, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran.
World Neurosurg. 2018 Sep;117:413-418. doi: 10.1016/j.wneu.2018.06.203. Epub 2018 Jul 2.
Central nervous system tuberculoma is the most severe manifestation of extrapulmonary tuberculosis with high mortality. Cavernous sinus tuberculoma (CST) is a very rare central nervous system tuberculoma with few cases reported in the literature.
A 57-year-old woman was admitted to our clinic with acute diplopia and headache limited to the right side. There was no specific medical history except for migraine, depression, and anxiety, all of which were controlled by oral medications. Physical examination revealed ptosis and mydriasis in the right eye, which indicated right third and sixth cranial nerve palsies. Pituitary magnetic resonance imaging showed a right parasellar lesion at the cavernous sinus wall and ophthalmic nerve. Laboratory examinations and brain computed tomography scan showed negative findings. Initial differential diagnosis included meningioma, sarcoidosis, tuberculoma, and lymphoma. However, results of further studies, including blood and cerebrospinal fluid cultures and Mycobacterium tuberculosis DNA assay, were negative. Biopsy of the cerebral lesion was performed through the subfrontal approach, and histopathologic study confirmed CST. She was treated with a standard antituberculous regimen. After 12 months of follow-up, no cerebral or clinical findings were seen.
CST is a rare presentation of M. tuberculosis, and the diagnosis is a difficult challenge. However, accurate diagnosis and timely treatment of CST can result in complete cure.
中枢神经系统结核瘤是肺外结核最严重的表现形式，死亡率高。海绵窦结核瘤（CST）是一种非常罕见的中枢神经系统结核瘤，文献报道的病例很少。
一名57岁女性因急性复视和局限于右侧的头痛入院。除偏头痛、抑郁症和焦虑症外，无特殊病史，所有这些均通过口服药物控制。体格检查发现右眼上睑下垂和瞳孔散大，提示右侧第三和第六脑神经麻痹。垂体磁共振成像显示海绵窦壁和眼神经处有右侧鞍旁病变。实验室检查和脑部计算机断层扫描显示阴性结果。初步鉴别诊断包括脑膜瘤、结节病、结核瘤和淋巴瘤。然而，包括血液和脑脊液培养以及结核分枝杆菌DNA检测在内的进一步研究结果均为阴性。通过额下入路对脑部病变进行活检，组织病理学研究证实为CST。她接受了标准抗结核治疗方案。随访12个月后，未发现脑部或临床异常。
CST是结核分枝杆菌的一种罕见表现形式，诊断具有挑战性。然而，准确诊断并及时治疗CST可实现完全治愈。
