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Case No. 389
2015-11-01~2015-11-30
출제자 : 유인선
Hit : 321
| Period | 2015-11-01~2015-11-30 |
|---|---|
| Diagnosis | Tb granuloma |
| Clinical information | M/67 C.C> 일주일전 시작된 gait disturbance |
| Discussion | * CNS tuberculosis is almost always secondary -tuberculous meningitis -localized parenchymal infection (tuberculous granuloma/tuberculoma (common), Tb abscess (rare)) * Tuberculoma: -noncaseating, caseating with solid center or caseating with necrotic center -hematogenous spread or extension of meningitis into parenchyma via cortical veins or small perforators -Typically parenchymal (supratentorial (m/c), infratentorial (rare)), dural tuberculomas may occur * Imaging findings of tuberculous granuloma (tuberculoma) -CT Hypo to hyperdense round or lobulated nodule/mass with moderate to marked edema Ca++ uncommon (~20%) Solid or ring enhancement -MR Noncaseating granuloma: hyperintense on T1, hypointense to brain on T2, nodular homogeneous enhancement Caseating granuloma: solid center, hypointense or isointense on T1 and hypointense on T2; necrotic center, central hypointensity on T1 and hyperintensity on T2, may have hyperintense rim (paramagnetic material) on T1, peripheral rim enhancement Surrounding edema, common |
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