Villoria M F, Fortea F, Moreno S, Muñoz L, Manero M, Benito C
Department of Radiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Radiol Clin North Am. 1995 Jul;33(4):805-20.
CNS TB represents a disease that complicates AIDS with an increasing incidence in endemic areas as well as in developed countries in those patients who have some risk factors such as intravenous drug abuse. Although TB infection of the CNS in AIDS patients may follow a rapidly progressive course, the imaging findings otherwise are similar to those of the nonimmunosuppressed population. Meningeal enhancement, hydrocephalus, parenchymal granulomata, and infarcts are seen frequently and are often observed in combination with one another. Nevertheless, the differential diagnosis in AIDS patients must include other opportunistic infections and primary or metastatic lymphoma of the CNS. Spinal TB usually is seen in the form of epidural abscess secondary to tuberculous spondylitis, although it may be seen in isolation of spinal column involvement. The differential diagnosis includes spinal lymphoma or pyogenic abscess formation. Radiculomyelitis or isolated spinal cord tuberculomata are much less frequently observed and can be suspected on imaging only if there is concomitant evidence of the classic findings of intracranial TB.
中枢神经系统结核是一种使艾滋病病情复杂化的疾病，在流行地区以及有静脉药物滥用等危险因素的发达国家患者中发病率不断上升。尽管艾滋病患者中枢神经系统的结核感染可能呈快速进展过程，但影像学表现与非免疫抑制人群相似。脑膜强化、脑积水、实质肉芽肿和梗死很常见，且常相互合并出现。然而，艾滋病患者的鉴别诊断必须包括其他机会性感染以及中枢神经系统的原发性或转移性淋巴瘤。脊柱结核通常表现为结核性脊柱炎继发的硬膜外脓肿，尽管也可能单独出现脊柱受累情况。鉴别诊断包括脊柱淋巴瘤或化脓性脓肿形成。神经根脊髓炎或孤立的脊髓结核瘤则较少见，只有在伴有颅内结核典型表现的证据时，影像学上才能怀疑。
