다발성 뇌결핵종을 동반한 속립결핵 1례

박선영,이정현,정낙균,김진택,정승연,강진한,Park, Sun Yung,Lee, Jung Hyun,Chung, Nak Gyun,Kim, Jin Tack,Chung, Seung Yun,Kang, Jin Han 대한소아감염학회 2000 Pediatric Infection and Vaccine Vol.7 No.2

국내에서 소아의 중증 결핵 환자는 사회경제적 발달과 BCG 백신의 적극적 접종으로 인하여 현저히 빈도수가 감소하였다. 저자들은 BCG 접종을 생후 4주에 실시했음에도 불구하고 가족내의 결핵 환자 발생이 인지되지 않아 조기 치료의 기회를 놓침으로서 속립결핵과 뇌결핵종의 합병증이 유발된 중증 결핵 환아 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. The incidence of tuberculosis has been decreased, and especially the incidence of severe complicated tuberculosis has been markedly decreased as the result of widely used BCG vaccines. But tuberculosis is still an important community accquired infectiouse disease in the world despite continued worldwide efforts to control the disease. Miliary tuberculosis, the most serious complicated tuberculosis, can be occurred by lymphohematogenous dissemination of tuberculosis, and intracranial tuberculoma with or without tuberculosis meningitis can be developed in case of miliary tuberculosis. In general, serious tuberculosis infections such as miliary tuberculosis and CNS tuberculosis are developed especially in young infants and children in cases of delayed diagnosis and treatment despite receiving BCG vaccination, and usually those patients have contact sources. Intrcranial tuberculoma in children are usually found near infratentorial site at the base of cerebellum, and clinically symptoms and signs of increased intracranial pressure developed before treatment. Serial brain CT or MRI is a good non-invasive diagnostic modality of intracranial tuberculoma. Although surgical intervention was initially advocated as the mainstay of intracranial tuberculoma therapy, but many recent clinical studies indicate that intracranial tuberculoma can be cured with medical treatment alone. We experienced a case of 3 months old male patient, who was diagnosed as having miliary tuberculosis associated with multiple intracranial tuberculoma. He received BCG vaccination at 4 weeks after birth, and his father was confirmed as active pulmonary tuberculosis patient after this patient's admission. We report this case with a review of related literatures.

항결핵제에 다른 반응을 보인 속립성 폐 결절과 두개강내 결절

박광영 ( Kwang Young Park ),이호진 ( Ho Jin Lee ),정재욱 ( Jae Wook Jung ),최윤희 ( Yoon Hee Choi ),남승범 ( Seung Bum Nam ),안세한 ( Se Han Ahn ),김철현 ( Cheol Hyeon Kim ),이재철 ( Jae Cheol Lee ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.2

Although a paradoxical response of tuberculosis to antituberculous therapy is not a rare phenomenon, it can be a clinical challenge to differentiate a paradoxical response from treatment failure. A 25-year-old woman was admitted for miliary lung nodules and multiple intracranial nodules. Antituberculous treatment was started with a preliminary diagnosis of tuberculosis based on the history and clinical findings. After one month, the military lung nodules improved while the intracranial nodules increased in size and number. Based on a stereotactic biopsy, it was confirmed that the intracranial lesions were tuberculomas. Although the therapeutic regimen was not changed, the symptoms eventually were ameliorated and the intracranial nodules improved two months later. (Tuberc Respir Dis 2008;64:153-157)

범발성 두개내 결핵종 완치 1례

라은영,이창우,La, Eun Young,Lee, Chang Yoo 대한소아감염학회 2002 Pediatric Infection and Vaccine Vol.9 No.1

어린 영유아에서 결핵성 육아종 및 결핵성 수막염, 속립성 결핵 등의 중증 결핵은 치료 시작시 임상상태와 밀접한 연관이 있으며 경과가 진행될수록 예후가 좋지 못하다. 본 증례에서는 결핵성 육아종과 함께 결핵성 수막염 및 속립성 결핵이 동반된 영아에서 12개월 동안 항결핵 요법을 시행한 후 특별한 임상적, 이학적, 신경학적 이상 소견 없는 완치를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Although the incidence of intracranial tuberculosis in children have been decreased with development of antituberculous therapy, mortality rate is still high as formerly if the diagnosis and treatment was not performed early. Authors report a case of a 5-month old male with multiple intracranial tuberculoma who have been accompanied by miliary tuberculosis and tuberculous meningitis. He was hospitalized at the pediatric department of Wonkwang University Hospital with mild fever and persistent cough. The brain MRI was performed and showed that there were multiple intracranial micronodular densities, perinodular edema and diffuse leptomeningeal enhancement which were disappeared completely after antituberculosis chemotherapy for 12 months and he had completely recovered without sequale.

뇌 결핵종의 임상적 연구

반순필,최종현,도종웅,김조영 대한신경외과학회 1984 Journal of Korean neurosurgical society Vol.13 No.3

We have experienced 10 cases of intracranial tuberculoma which were confirmed by CT scan in National Medical Center from Jan. '79 to Aug. '82. The analysis is based on 10 cases with intracranial tuberculoma on whom operation -was performed in 7 cases and conservative treatment was done in 3 cases. Extracranial disease or a past history of tuberculosis are evident in half of patients. The common presenting features are intracranial hypertension and papilledema. These are usually located in the supratentorial region. The use of CT brain scanning can be of great help in diagnosis and follow up more than others. The current treatment consists of medical therapy such as combined antituberculous agents, but surgical exploration may be reserved for intractable seizure, suspected brain tumor and medical failure or severe intracranial hypertension.

수막종과 구별하기 어려운 뇌결핵종 : 증례보고 Case Report

강재규,신해철,최종현,도종웅 대한신경외과학회 1984 Journal of Korean neurosurgical society Vol.13 No.3

Intracranial tuberculoma may imitate, both clinically and radiologically, the more commonly observed intracranial tumors. A 16 year old female patient was admitted due to exophthalmus(o.d) and headache. Neurologically papilledema was noted on the both fundus and exophthalmometry revealed that exophthalmus (17㎜, 13㎜). CT brain scan showed slightly high density lesion with surrounding low density in right frontotemporal area, attached to the sphenoid bone. And also hyperostosis was noted at the right sphenoid bone and dense homogeneous enhancement of mass after contrast infusion was seen. This case reports outlines the development of such a lesion masquerading as a typical meningioma of the sphenoid ridge. Discussion of intracranial tuberculoma follows, with special reference to clinical and radiological findings.

Coexistence of Spinal Intramedullary Tuberculoma and Multiple Intracranial Tuberculomas

Dong-Yoon Lee,Sang Pyo Kim,In Soo Kim 대한척추신경외과학회 2015 Neurospine Vol.12 No.2

Spinal intramedullary tuberculoma remains a very rare entity of central nervous system tuberculosis. This is the same with the coexistence of spinal intramedullary and intracranial tuberculomas that remains extremely rare with less than 20 cases reported at present. Authors describe this uncommon case by analyzing a 65-year-old female patient who had past history of kidney transplantation due to stage 5 chronic kidney disease and pulmonary tuberculosis on medication. The patient experiences progressive paraplegia and numbness on both lower extremities. Magnetic resonance imaging demonstrated an intramedullary mass at T9-10 level and multiple intracranial enhancing nodules. Microsurgical resection of spinal intramedullary mass was performed and the lesion was histopathologically confirmed as Mycobacterium tuberculosis. Efficient diagnosis and management of this rare disease are reviewed along with previously reported cases.

뇌하수체 결핵종 1예 보고 : 증례 보고 Case Report

조준,조병일 대한신경외과학회 1991 Journal of Korean neurosurgical society Vol.20 No.5

The authors describe a case of pituitary tuberculoma in 45 year old female patient with previous history of tuberculous meningitis. Her clinical complaints were headache, visual field defects and amenorrhea. Endocrinological studies showed hypopituitarism. Radiological studies including CT showed tumor mass in the sella turcica and suprasella area & paietal lobe. Ramamurthi and Varadarajan described the two types of the intracranial tuberculoma ; 1) A superficial and vascular type requires operation only in selected cases and it responds favoratly to treatment. 2) A deep and avascular type accompanied by increased intracranial tension and a spaceoccupying lesion, which does not respond to medical treatment and requires operation. Removal of the pituitary tuberculoma by T.S.A. followed by antituberculous treatment resulted in resolution of her neurological symptoms and signs.

반복되는 특발성 늑막삼출의 과거력이 있었던 환아에서 발생한 두개내 결핵종 1례

윤성관(Sung Kwan Yoon),문경래(Kyung Rye Moon),노영일(Young Il Rho) 대한소아신경학회 2002 대한소아신경학회지 Vol.10 No.1

저자들은 8세 8개월된 소아에서 반복적인 원인 모르는 늑막 삼출의 과거력이 있었던 환아에서 결핵성 뇌수막염과 두개내 결핵종이 발병하여 척수액 검사와 뇌 자기공명영상으로 진단 후 항결핵제와 스테로이드 치료로 호전되어 특별한 후유증 없이 8개월간 추적검사 중인 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Central nervous system(CNS) involvement by tuberculosis is uncommon in comparison to the involvement of other systems. Untreated tuberculous meningitis is characterized by progressive stupor and a fatal outcome within 4 to 8 weeks of the onset of symptoms. So rapid detection of Mycobacterium tuberculosis is of vital importance for these patients. In almost all patients with tuberculous meningitis, acid-fast bacteria are undetectable in the CSF. Culture techniques that permit the identification of the isolated mycobacterial species require several weeks. We report a case of tuberculous meningitis with intracranial tuberculoma in 8-year old male who experienced pleural effusion, repeatedly. CSF findings did not reveal diagnosis tuberculous meningitis. In MRI study, multiple intracranial tuberculomas were located at the cerebellum. Prolonged treatment with anti- tuberculous chemotherapy and

속립결핵과 다발성 뇌결핵종, 증례 1례

강희동,전철수,이경일,한지환,이형신,최진,허재균,황경태,Kang, Hee-Dong,Jun, Chul-Soo,Lee, Kyung-Yil,Han, Ji-Hwan,Lee, Hyung-Shin,Choi, Jin,Herm, Jae-Kyun,Hwang, Kyung-Tai 대한소아감염학회 2001 Pediatric Infection and Vaccine Vol.8 No.2

Although the incidence of tuberculosis has been decreased, it is still an important community acquired infectious disease in the world. Miliary or disseminated tuberculosis occurs from the inadequacy of host defense in controling tuberculous infection. Generally, brain parenchyme has been considered to be a rare involving organ than other organs or meninges in miliary tuberculosis. However it has been proving that the brain parenchyme is commonly involved organ in miliary tuberculosis even without neurological manifestations. We report a case of 8 yr-old male patient, who was diagnosed as having an miliary tuberculosis with multiple tuberculoma throughout the brain. The tuberculous lesions of lung and brain were nearly cleared within 3 months with anti-tuberculous therapy. With a reveiw of related literatures, we suggest that the patients with miliary tuberculosis should be evaluateded about brain involvement. 속립성 결핵은 개체의 면역이상으로 결핵균이 전신의 장기에 파종될 시 나타난다. 최근에는 뇌조직도 흔히 침범되는 장기의 하나로 인식되고 있으며 뇌조직에서도 다발성 병변을 보이는 것이 일반적이다. 저자들은 두통과 미열을 주소로 입원한 8세 남아에서 방사선학적 소견과 위액 흡입에 의한 배양 결과로 확진된 속립성 결핵과 두개내 다발성 결핵종을 경험하여 문헌 고찰과 함께 보고하였다. 속립성 결핵이 의심되는 경우에 신경학적 증상의 유무에 관계없이 중추신경계의 영상 검사가 필요하다.

천막 수막종으로 오인했던 결핵종의 치료

양나래(Na-Rae Yang),서의교(Eui-Kyo Seo),구혜수(Hye Soo Koo) 대한두개저학회 2010 대한두개저학회지 Vol.5 No.2

We report the case of a 44-year-old woman who presented with a headache and right sixth cranial nerve palsy. The lesion mimicked a tentorial meningioma in the brain and was investigated using computed tomography and magnetic resonance imaging. Gross total resection was achieved using a subtemporal approach. Histologic examination of the mass revealed the typical tuberculoma such as granulomas with caseous necrosis. Postoperative antituberculous medication led to complete resolution of neurological symptoms and radiological examinations. Intracranial tuberculoma is an uncommon disease. Early diagnosis and adequate treatment is important in postoperative prognosis.