Garg Ravindra Kumar, Paliwal Vimal, Suvirya Swastika, Malhotra Hardeep Singh, Verma Anoop
Department of Neurology, King George's Medical University, India.
Department of Neurology, Sanjay Gandhi Institute of Medical Sciences, India.
Neuroradiol J. 2024 Oct;37(5):556-563. doi: 10.1177/19714009241240055. Epub 2024 Mar 14.
This systematic review aimed to evaluate the published cases with miliary brain lesions and their etiological factors, clinical manifestations, diagnostic procedures, and outcomes.
A comprehensive search of PubMed, Scopus, Embase, and Google Scholar was conducted using the specified search strategy. Eligibility criteria included cases with miliary lesions in the brain confirmed through neuroimaging and various diagnostic procedures. The PRISMA guidelines were followed, and the PROSPERO registration number for the protocol is CRD42023445849.
Data from 130 records provided details of 140 patients. Tuberculosis was the primary cause in 93 cases (66.4%), malignancies in 36 cases (25.7%), and other causes accounted for the remaining 11% cases. Tuberculosis patients averaged 35.7 years old, while those with malignancies averaged 55.44 years. Tuberculosis symptoms primarily included fever, headache, and altered sensorium, whereas malignant cases often exhibited progressive encephalopathy, headache, and specific neurological deficits. Distinctive indicators for CNS tuberculosis were choroidal tubercles and paradoxical reactions. Additionally, 63 tuberculosis patients showed miliary lung shadows and 49 had abnormal CSF findings. For the malignancy group, 13 exhibited miliary lung lesions, and 8 had CSF abnormalities. Regarding outcomes, a significant mortality disparity was observed, with 58.3% in the malignancy group, compared to 10.8% in the tuberculosis group and 27.3% in other cases.
Miliary brain lesions are a crucial imaging abnormality that necessitates prompt work up. In an immunocompromised state, diagnostic possibilities of miliary brain lesions are more varied and often pose a bigger challenge.
本系统评价旨在评估已发表的粟粒性脑病变病例及其病因、临床表现、诊断方法和预后。
采用指定的检索策略对PubMed、Scopus、Embase和谷歌学术进行全面检索。纳入标准包括经神经影像学和各种诊断方法确诊的脑粟粒性病变病例。遵循PRISMA指南，该方案的PROSPERO注册号为CRD42023445849。
130条记录的数据提供了140例患者的详细信息。93例（66.4%）的主要病因是结核病，36例（25.7%）是恶性肿瘤，其余11%为其他病因。结核病患者平均年龄为35.7岁，而恶性肿瘤患者平均年龄为55.44岁。结核病症状主要包括发热、头痛和意识改变，而恶性肿瘤病例常表现为进行性脑病、头痛和特定的神经功能缺损。中枢神经系统结核病的特征性指标是脉络膜结核结节和反常反应。此外，63例结核病患者有粟粒性肺阴影，49例脑脊液检查结果异常。恶性肿瘤组中，13例有粟粒性肺病变，8例脑脊液异常。关于预后，观察到显著的死亡率差异，恶性肿瘤组为58.3%，结核病组为10.8%，其他病例为27.3%。
粟粒性脑病变是一种关键的影像学异常，需要及时检查。在免疫功能低下的状态下，粟粒性脑病变的诊断可能性更多样化，且往往带来更大挑战。
