Çetin Fatma Tuğba, Gündeşlioğlu Özlem Özgür, Kaya Ömer, Bakanoğlu Emel, Kaya Bedir, Çay Ümmühan, Alabaz Derya, Totik Nazlı
Faculty of Medicine Department of Pediatric Infection, Cukurova University, Adana, Turkey.
Faculty of Medicine Department of Radiology, Cukurova University, Adana, Turkey.
Childs Nerv Syst. 2025 Apr 16;41(1):161. doi: 10.1007/s00381-025-06820-6.
Tuberculomas represent a significant complication of central nervous system (CNS) infection resulting from tuberculosis. The objective of our study was to evaluate the demographic and clinical characteristics, diagnosis, treatment, and prognosis of pediatric patients with CNS tuberculoma.
The study population comprised patients aged 0-18 years who were diagnosed with CNS tuberculoma in the Division of Pediatric Infectious Diseases at Cukurova University Balcali Hospital between January 1, 2002, and September 1, 2024. A retrospective analysis was conducted on the files to examine the demographic and clinical characteristics, radiological data, and treatment of the patients. The definitive diagnosis was established through acid-fast bacilli staining and tuberculosis culture of the CNS lesion. The probable diagnosis was made on the basis of clinical epidemiologic factors, histopathology, molecular methods, and typical radiographic findings.
CNS was tuberculoma detected in 22 patients (8.3%) of the 265 individuals diagnosed with TB. Of the total number of patients, 12 (54.5%) were male and 10 (45.5%) were female. The median age of the patients was 60 months (25th to 75th interquartile range 15.8 and 144.0, respectively), and the most common presenting complaint was fever (77.3%). A lumbar puncture was conducted in 19 patients (86.4%), and brain imaging was performed on all of them. Biopsies from the brain lesions were obtained in two patients. The mean follow-up period was 9.3 ± 5.4 years. The antituberculosis treatment was administered until the lesions had disappeared. Complete recovery was observed in 14 patients (63.6%), while eight patients (36.4%) exhibited sequelae. Tuberculoma did not result in mortalities among the patients.
Diagnosis of CNS tuberculoma is often difficult due to non-specific symptoms and difficulties in sampling. Early diagnosis and appropriate treatment can prevent mortality and morbidity. When we encounter suspicious radiologic findings in brain imaging, especially magnetic resonance imaging, it should be considered in the differential diagnosis.
结核瘤是由结核病引起的中枢神经系统（CNS）感染的一种重要并发症。我们研究的目的是评估患有中枢神经系统结核瘤的儿科患者的人口统计学和临床特征、诊断、治疗及预后。
研究人群包括2002年1月1日至2024年9月1日期间在库库洛瓦大学巴尔卡利医院儿科传染病科被诊断为中枢神经系统结核瘤的0至18岁患者。对这些患者的病历进行回顾性分析，以检查其人口统计学和临床特征、放射学数据及治疗情况。通过对中枢神经系统病变进行抗酸杆菌染色和结核培养来确立明确诊断。基于临床流行病学因素、组织病理学、分子方法及典型的影像学表现做出可能的诊断。
在265例诊断为结核病的患者中，有22例（8.3%）检测到中枢神经系统结核瘤。在所有患者中，12例（54.5%）为男性，10例（45.5%）为女性。患者的中位年龄为60个月（第25至75百分位数的四分位间距分别为15.8和144.0），最常见的主诉是发热（77.3%）。19例患者（86.4%）进行了腰椎穿刺，所有患者均进行了脑部影像学检查。2例患者获取了脑病变组织活检样本。平均随访期为9.3±5.4年。抗结核治疗持续至病变消失。14例患者（63.6%）完全康复，而8例患者（36.4%）有后遗症。结核瘤在患者中未导致死亡。
由于症状不特异及取样困难，中枢神经系统结核瘤的诊断往往具有挑战性。早期诊断和适当治疗可预防死亡和发病。当在脑部影像学检查尤其是磁共振成像中遇到可疑的影像学表现时，应在鉴别诊断中予以考虑。
