Whiteman M, Espinoza L, Post M J, Bell M D, Falcone S
Department of Radiology, University of Miami School of Medicine, FL 33136, USA.
AJNR Am J Neuroradiol. 1995 Jun-Jul;16(6):1319-27.
To characterize the radiographic findings on neuroimaging of 25 human immunodeficiency virus (HIV)-seropositive patients with proved central nervous system tuberculosis and to correlate those findings with clinical data.
Twenty-five HIV-seropositive patients with central nervous system tuberculosis were identified, and their imaging studies (CT and, in some cases, MR) and medical records were reviewed. The diagnosis of central nervous system tuberculosis was based on cerebrospinal fluid culture (n = 20), biopsy (n = 4), and/or autopsy (n = 5), with a clinical diagnosis of central nervous system tuberculosis in one additional patient. Results also were correlated with CD4 counts and chest x-ray findings.
Nine (36%) of 25 patients demonstrated meningeal enhancement. Eleven (44%) of 25 demonstrated enhancing parenchymal lesions; 6 patients had tuberculomata, and 5 had tuberculous abscesses. Communicating hydrocephalus was present in 8 (32%) of 25, and infarction was seen in 9 (36%) of 25. Fifteen of 23 chest x-rays were suggestive of pulmonary tuberculosis. Mean CD4 count was 162. Nine (38%) of 24 patients had a history of pulmonary tuberculosis, and 5 (21%) of 24 had no history of tuberculosis or any other opportunistic infection. Overall mortality was 79%.
Central nervous system tuberculosis has a very high mortality among HIV-infected patients. Because cerebrospinal fluid cultures can take 6 to 8 weeks, the neuroradiologist can play a critical role in patient treatment by suggesting the correct diagnosis based on characteristic imaging findings. Radiographic clues include multiloculated abscess, cisternal enhancement, basal ganglia infarction, and communicating hydrocephalus, which are not findings associated with the more commonly encountered central nervous system lymphoma or toxoplasma encephalitis. Central nervous system tuberculosis may be the initial presentation of acquired immunodeficiency syndrome. In patients with suspected central nervous system tuberculosis, chest x-ray may provide additional support for the diagnosis of tuberculosis.
描述25例经证实患有中枢神经系统结核的人类免疫缺陷病毒（HIV）血清学阳性患者的神经影像学表现，并将这些表现与临床数据相关联。
确定25例HIV血清学阳性的中枢神经系统结核患者，并回顾他们的影像学研究（CT以及部分病例的MR）和病历。中枢神经系统结核的诊断基于脑脊液培养（n = 20）、活检（n = 4）和/或尸检（n = 5），另有1例患者为临床诊断中枢神经系统结核。结果还与CD4细胞计数和胸部X线表现相关。
25例患者中有9例（36%）表现为脑膜强化。25例中有11例（44%）表现为脑实质强化病变；6例有结核瘤，5例有结核性脓肿。25例中有8例（32%）存在交通性脑积水，25例中有9例（36%）可见梗死。23例胸部X线中有15例提示肺结核。平均CD4细胞计数为162。24例患者中有9例（38%）有肺结核病史，24例中有5例（21%）无结核病史或任何其他机会性感染病史。总体死亡率为79%。
中枢神经系统结核在HIV感染患者中死亡率极高。由于脑脊液培养可能需要6至8周，神经放射科医生可根据特征性影像学表现提出正确诊断，从而在患者治疗中发挥关键作用。影像学线索包括多房性脓肿、脑池强化、基底节梗死和交通性脑积水，这些表现并非更常见的中枢神经系统淋巴瘤或弓形虫脑炎的表现。中枢神经系统结核可能是获得性免疫缺陷综合征的首发表现。对于疑似中枢神经系统结核的患者，胸部X线可能为结核诊断提供额外支持。
