Wagué Daouda, Manneh Ebrima Kalilu, Sène Fatou, Djigo Richard Salif, Mbaye Maguette, Thioub Mbaye
Department of Neurosurgery, Fann National University Hospital, Dakar, Senegal.
Cheikh Anta Diop University, Dakar, Senegal.
Surg Neurol Int. 2025 Apr 11;16:131. doi: 10.25259/SNI_67_2025. eCollection 2025.
Diagnosis of brain tumors increased in sub-Saharan Africa since the advent of computed tomography (CT)-scans and magnetic resonance imaging (MRI) in these regions, enabling easy diagnosis. However, some histological types of brain tumors can be confusing, especially on CT-scan, simulating other pathologies such as inflammatory granulomas or pyogenic abscesses. MRI, in this instance, with its diffusion-weighted imaging, susceptibility weighted imaging, or perfusion imaging, is important to help with accurate diagnosis. The down side of these imaging facilities, however, is that less and less importance is accorded to proper and detailed history taking. Such a care-free attitude to history taking can be costly, especially in resource strained environments.
We report the case of a 06-year-old child who presented with seizures associated with headaches and vomiting. In this case, proper history taking following the surgical intervention revealed a history of head trauma after a fall with a scalp wound, which was suppurated but later progressed well. The CT scan showed a solid cystic lesion. The first component is a ring enhanced portion (hyperdense ring with the hypodense center, surrounded by edema) with central calcification located in the frontal region, and the second component is a cystic portion located in the temporal region. This lesion with dual component was more suggestive of a tumoral lesion on imaging than an abscess. The child did not benefit from further imaging due to unavailability in the region as well as the socioeconomic status of the family making them incapable of going elsewhere to do it. A decision to surgically excise the lesion was made, and during surgery, we found a well-circumscribed yellowish lesion associated with an arachnoid cyst. The capsule of the lesion was very thick, and after opening it, the content was pus combined with debris. The child did well on antibiotic therapy post-surgery. The follow-up was unremarkable.
Brain MRI is essential to differentiate some pyogenic brain abscesses from tumors. However, meticulous history taking is important to gather as much information as possible about any medical pathology, which would then be corroborated with the physical examination findings and imaging to increase diagnostic accuracy and minimize misdiagnosis.
自从计算机断层扫描（CT）和磁共振成像（MRI）在撒哈拉以南非洲地区出现以来，该地区脑肿瘤的诊断率有所上升，这使得脑肿瘤易于诊断。然而，某些组织学类型的脑肿瘤可能会造成混淆，尤其是在CT扫描上，它们会模拟其他病变，如炎性肉芽肿或化脓性脓肿。在这种情况下，MRI及其扩散加权成像、磁敏感加权成像或灌注成像对于准确诊断很重要。然而，这些成像设备的缺点是，人们越来越不重视详细的病史采集。这种对病史采集满不在乎的态度可能代价高昂，尤其是在资源紧张的环境中。
我们报告一例6岁儿童，表现为伴有头痛和呕吐的癫痫发作。在这个病例中，手术干预后进行的详细病史采集发现，该儿童有跌倒后头部外伤史，伴有头皮伤口，伤口化脓但后来恢复良好。CT扫描显示一个实性囊性病变。第一部分是一个环形强化部分（中心低密度、周围有水肿的高密度环），中央钙化位于额叶区域，第二部分是位于颞叶区域的囊性部分。这个具有双重成分的病变在影像学上比脓肿更提示肿瘤性病变。由于该地区无法提供进一步的成像检查，且家庭的社会经济状况使其无法前往其他地方进行检查，该儿童未能接受进一步的成像检查。于是决定手术切除病变，手术中我们发现一个边界清晰的淡黄色病变，与一个蛛网膜囊肿有关。病变的包膜非常厚，打开后，内容物是脓液和碎屑。该儿童术后抗生素治疗效果良好。随访情况良好。
脑MRI对于鉴别一些化脓性脑脓肿和肿瘤至关重要。然而，细致的病史采集对于收集有关任何医学病理的尽可能多的信息很重要，然后将这些信息与体格检查结果和影像学检查结果相互印证，以提高诊断准确性并尽量减少误诊。
