Rajshekhar V, Haran R P, Prakash G S, Chandy M J
Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, India.
J Neurosurg. 1993 Mar;78(3):402-7. doi: 10.3171/jns.1993.78.3.0402.
It is commonly believed that differentiating solitary small cysticercus granulomas and small tuberculomas in patients with seizures is difficult without resorting to an excision biopsy. The aim of this study was to formulate clinical and computerized tomography (CT) criteria to distinguish these two entities in patients with epilepsy. Toward this end, clinical and CT data from six consecutive patients with histologically proven small solitary tuberculomas and 25 consecutive patients with histologically proven solitary cysticercus granulomas were compared. Evidence of raised intracranial tension and a progressive focal neurological deficit was seen only in patients with tuberculomas (two of six cases). All tuberculomas were greater than 20 mm in size and five of the six were irregular in outline. Only tuberculomas were associated with a midline shift on CT (four of six cases). All cysticercus granulomas were less than 20 mm in size and 24 (96%) of the 25 were regular in outline, conforming to one of two characteristic patterns. No cysticercus granuloma was associated with a midline shift. Based on the above clinical findings (evidence of raised intracranial tension and a progressive neurological deficit) and CT criteria (size, shape, and association with a midline shift), it is possible to separate these two entities in a majority of patients with seizures and with a single small lesion on CT.
人们普遍认为，在不进行切除活检的情况下，区分癫痫患者的孤立性小囊尾蚴肉芽肿和小结核瘤是困难的。本研究的目的是制定临床和计算机断层扫描（CT）标准，以区分癫痫患者中的这两种病变。为此，对连续6例经组织学证实为小孤立性结核瘤的患者和连续25例经组织学证实为孤立性囊尾蚴肉芽肿的患者的临床和CT数据进行了比较。仅在结核瘤患者中观察到颅内压升高和进行性局灶性神经功能缺损的证据（6例中的2例）。所有结核瘤大小均大于20mm，6例中有5例轮廓不规则。仅结核瘤在CT上伴有中线移位（6例中的4例）。所有囊尾蚴肉芽肿大小均小于20mm，25例中有24例（96%）轮廓规则，符合两种特征性模式之一。没有囊尾蚴肉芽肿伴有中线移位。基于上述临床发现（颅内压升高和进行性神经功能缺损的证据）和CT标准（大小、形状以及与中线移位的关系），在大多数癫痫且CT上有单个小病变的患者中可以区分这两种病变。
