RESUMEN
A 34-year-old Vietnamese patient presented with tuberculous meningoencephalitis complicated by hydrocephalus, diabetes insipidus, and radiological evidence of skull base erosion. Despite antituberculous treatment and corticosteroids multiple basal tuberculomas developed. Because of unusual CT and MRI findings casting some doubt on the diagnosis, brain biopsy was performed. The histological finding of an intracerebral tuberculoma supported the initial diagnosis. Some aspects of differential diagnosis and therapy are discussed, with reference to this case.
Asunto(s)
Antituberculosos/uso terapéutico , Cráneo , Tuberculoma/diagnóstico , Tuberculosis Meníngea/diagnóstico , Tuberculosis Osteoarticular/diagnóstico , Adulto , Antituberculosos/efectos adversos , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos X , Tuberculoma/tratamiento farmacológico , Tuberculosis Meníngea/tratamiento farmacológico , Tuberculosis Osteoarticular/tratamiento farmacológicoRESUMEN
A 66-year-old man presented with right cerebellar infarction and ischemic lesions in the left dorsal thalamus and right upper parietal lobe. Angiography showed occlusion of the right internal carotid artery proximal to an ipsilateral proatlantal artery type I, 70% stenosis of the left internal carotid artery, and aplasia of both posterior communicating arteries. The carotid occlusion was successfully treated by thrombendarterectomy. Persistence of a proatlantal artery is a rare condition. In relation to the 38 literature reports on proatlantal arteries, this case demonstrates the clinical significance of a persistent proatlantal artery in the evolution of atypical ischemic cerebrovascular disease.