RESUMO
CONTEXT: Intracranial tuberculomas are rare yet lethal forms of tuberculosis. Diagnosis is often difficult because of its nonspecific symptoms and radiological findings. AIM: This study aims to perform a literature review of multiple tuberculomas to improve disease recognition and management in immunocompetent patients along with presenting a case report on the topic. DATA SOURCES: Scopus, LILACS, Ovid MEDLINE and EMBASE. STUDY SELECTION: Case reports and case series up to December 2018 in English, Spanish, and Portuguese focusing on intracranial tuberculomas in adult and pediatric immunocompetent patients. Data on presentation, diagnostic workup, and treatment was analyzed. DATA EXTRACTION: Cochrane Collaboration/Cochrane Handbook and PRISMA guidelines. RESULTS: Twenty reports involving 21 patients were included. Most patients were male (57.14%). The average age at diagnosis was 26.9 ± 14.9 years. Headache was the most common presenting symptom (52.4%; 11/21), followed by motor weakness (47.6%; 10/21) and vomiting (23.8%; 5/21). MRI was the most used image technique (17/21). Most lesions occurring in the cerebral hemispheres (16/21); we found five or more lesions in 66.6% (14/21) of the patients. The majority treated with anti-tuberculous drugs resulted in a favorable outcome. CONCLUSIONS: Immunocompetent patients living in TB endemic areas whose clinical evaluation and neuroimaging findings are compatible with tuberculoma should undergo anti-tubercular treatment despite a lack of bacteriological confirmation.
Assuntos
Antituberculosos/uso terapêutico , Encefalopatias/diagnóstico por imagem , Glucocorticoides/uso terapêutico , Tuberculoma Intracraniano/diagnóstico por imagem , Tuberculose Pulmonar/diagnóstico por imagem , Cegueira/fisiopatologia , Encéfalo/diagnóstico por imagem , Encefalopatias/tratamento farmacológico , Encefalopatias/imunologia , Encefalopatias/fisiopatologia , Ataxia Cerebelar/fisiopatologia , Dexametasona/uso terapêutico , Quimioterapia Combinada , Doenças Endêmicas , Etambutol/uso terapêutico , Feminino , Humanos , Imunocompetência , Isoniazida/uso terapêutico , Imageamento por Ressonância Magnética , Náusea/fisiopatologia , Nistagmo Patológico/fisiopatologia , Peru , Pirazinamida/uso terapêutico , Quadriplegia/fisiopatologia , Rifampina/uso terapêutico , Tomografia Computadorizada por Raios X , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculoma Intracraniano/imunologia , Tuberculoma Intracraniano/fisiopatologia , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/imunologia , Vômito/fisiopatologia , Adulto JovemRESUMO
INTRODUCTION: movement disorders have been associated with deep brain lesions. This study was performed to describe the frequency and characteristics of movement disorders in patients with intracranial tuberculomas. METHODS: patients admitted consecutively between 1989 and 2004 to the Neurology Service of Eugenio Espejo Hospital (Quito, Ecuador), with a diagnosis of intracranial tuberculomas. All patients were examined clinically, and laboratory tests and imaging studies performed. Follow-up continued up to one year after the tuberculosis treatment was completed. A nested case-control analysis was performed to compare clinical characteristics, number and location of tuberculomas, between cases with movement disorders and controls. RESULTS: forty-nine patients with tuberculomas (31.7±20.5 years; males 53.1%) were studied. We found 16 cases (32.6%; 95%CI=19.9% - 47.5%) of movement disorders: chorea (n=7; 43.8%), tremor (n=5; 31.3%), dystonia (n=3; 18.8%) and myoclonus (n=1; 6.3%). Most cases (87.6%) developed early (10.4±5.2 days of hospitalization). On admission, patients with movement disorders showed higher severity of the illness than controls (68.7 vs. 30.3%; p=.01), along with greater motor impairment (75.0 vs. 39.4%; p=.01) and sensitivity impairment (43.8 vs. 9.1%; p=.01). The cases showed higher frequency of multiple tuberculomas (68.7 vs. 36.4%), with deep brain deep (31.3 vs. 21.2%) and more severe motor impairment (25.0 vs. 12.1%). CONCLUSIONS: our results suggest a causal relationship between tuberculomas and movement disorders. Deep location and multiple tuberculomas may increase the risk of develop movement disorders.
Assuntos
Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/fisiopatologia , Tuberculoma Intracraniano/complicações , Tuberculoma Intracraniano/fisiopatologia , Adolescente , Adulto , Idoso , Criança , Equador , Feminino , Humanos , Masculino , Transtornos dos Movimentos/patologia , Tuberculoma Intracraniano/patologia , Adulto JovemRESUMO
Tumor de Pott (Potts Puffy tumor) é uma comorbidade caracterizada por um ou mais abscessos sub-periosteais do osso frontal associados a osteomielite subjacente. As etiologias incluem trauma e sinusite, entre outras. Relatamos o caso de uma paciente de 17 anos que se apresentou com abaulameto doloroso, calor local e flutuação na região frontal à direita há um mês, bem como cefaléia holocraniana e hipertermia. O diagnóstico de Tumor de Pott como uma complicação de uma sinusite frontal foi estabelecido pela clínica e confirmado por tomografia computadorizada de crânio. Foi tratada com sucesso com esquema inicial de amoxicilina mais clavulanato, o qual foi substituído por ciprofloxacina, associados à craniotomia, com craniectomia do osso acometido. Esta é uma doença que por ser infreqüente muitas vezes não é diagnosticada. Deste modo enfatizamos o diagnóstico e tratamento precoces como forma de evitar seqüelas neurológicas.
Potts Puffy Tumor is a comorbidity characterized by one or multiple subperiosteal abscesses of the frontal bone associated with underlying osteomyelitis. Etiologies include trauma and sinusitis among others. Here we report the case of a 17-year-old female patient with painful bulging, local heat, and fluctuation in the frontal region on the right for a month, as well as holocranial headache and hyperthermia. The diagnosis of Potts Puffy Tumor as a complication of frontal sinusitis was clinically established and confirmed by computerized tomography of the skull. It was successfully initially treated with amoxicilin + clavunate, followed by ciprofloxacin, combined with craniotomy and craniectomy of the affected bone. Because of its rarity, this disorder often goes underdiagnosed. Thus we emphasize an early diagnosis and treatment so as to avoid neurological sequels.
Assuntos
Humanos , Adolescente , Abscesso/complicações , Abscesso/patologia , Osso Frontal/fisiopatologia , Osso Frontal/lesões , Osteomielite/complicações , Osteomielite/fisiopatologia , Sinusite Frontal/complicações , Sinusite Frontal/etiologia , Tuberculoma Intracraniano/complicações , Tuberculoma Intracraniano/etiologia , Tuberculoma Intracraniano/fisiopatologiaRESUMO
La neuralgia del trigénio (NT) se asocia con múltiples lesiones intra y extracraneanas como son la compresión vascular arterial o venosa, ateroesclerosis, esclerosis múltiple, malformaciones arteriovenosas, etc. Se piensa que algunas de estas lesiones intervienen en la patogenia de la NT. Se presenta el caso de una mujer de 72 años con NT unilateral secundaria a la presencia de tuberculomas bilaterales de la tienda del cerebelo, y del surco olfatorio. Murió como consecuencia de leptomeningitis tuberculosa. Se revisan los conceptos actuales de la patogenia de la NT
Assuntos
Idoso , Feminino , Doenças Cerebelares/patologia , Neuralgia do Trigêmeo/etiologia , Neuralgia do Trigêmeo/patologia , Tuberculoma Intracraniano/patologia , Tuberculoma Intracraniano/fisiopatologiaRESUMO
Se describe el tipo histologico de 140 tumores intracraneales, estudiados en los hospitales Nro.1 CNS (1965-1985) y Metodista (1967-1985) de La Paz, incluidos los tuberculomas. Los resultados revelan que los adenomas pituitarios son los mas frecuentes con un 23.17 por ciento ; seguidos de los astrocitomas (22.14 por ciento ); los meningiomas (15 por ciento ); los tuberculomas (13.57 por ciento ) y los tumores metastasicos (7.14 por ciento ).