Tuberculoma in the Medulla Oblongata and Medulla Spinalis:Two Case Reports

Year 2013, Volume: 2013 Issue: 4, 442 - 445, 01.04.2013

Salih Gülşen Hakan Caner

https://doi.org/10.5152/balkanmedj.2013.8985

Abstract

Tuberculoma in the Medulla Oblongata and Medulla Spinalis:Two Case Reports

Abstract

Background: Central nervous system tuberculosis remains a prevalent problem in developing countries. Also, this disease has been an important problem in developed countries due to the increased incidence of acquired immunodeficiency syndrome. Tuberculosis of the central nervous system is seen in 10% of immunocompetent patients with primary tuberculosis. Case Report: We report two patients with tuberculoma in the central nervous system. The first case had a lesion located in the medulla oblongata, and the second case had a lesion in the medulla spinalis between the 5th cervical and 1st thoracic vertebral level. Both of these patients underwent surgery. Conclusion: CNS tuberculomas may not always show typical magnetic resonance imaging (MRI) signs, but when a neurosurgeon encounters a brown-yellow rubber-like lesion that is easily extirpated from the glial tissue, tuberculoma should be considered; anti-tuberculous and corticosteroid therapy should be initiated as soon as possible to prevent meningitis and the immune-mediated destructive effects of tuberculosis on the CNS. Whether or not anti-tuberculous therapy is continued can be decided upon by following definitive pathologic diagnosis. Turkish Başlık Medulla Spinalis ve Medulla Oblongata İçinde Tüberkülom: İki Olgu Sunumu Arkaplan: Merkezi sinir sistem tüberkülozu gelişmekte olan ülkelerde yaygın bir sorun olmaya devam etmektedir. Bu hastalık, edinilmiş immün yetmezlik sendromunda insidans artışı nedeniyle gelişmiş ülkelerde de önemli bir sorun olmaktadır. Merkezi sinir sisteminin tüberkülozu primer tüberkülozlu immünokompetan hastaların %10'unda görülmektedir. Olgu Sunumu: Merkezi sinir sisteminde tüberkülomu olan iki olgu sunmaktayız. İlk vakada lezyon medulla oblongatada yerleşikti ve ikinci vakada 5. servikal ve 1. torakal vertebra seviyesi arasında medulla spinaliste bir lezyon vardı. Bu hastaların ikisi de ameliyat edildi. Sonuç: MSS tüberkülomları her zaman tipik manyetik rezonans görüntüleme (MRG) bulguları göstermeyebilir, ancak beyin cerrahı kolayca glial dokudan çıkarılan, sarı-kahverengi kauçuk benzeri bir lezyonla karşılaştığında, tüberkülom düşünülmelidir; menenjiti ve MSS üzerinde tüberkülozun immün-aracılı yıkıcı etkilerini önlemek için anti-tüberküloz ve kortikosteroid tedavisi mümkün olan en kısa sürede başlanmalıdır. Anti- tüberküloz tedaviye devam edilip edilmeyeceğine kesin patolojik tanıyı takiben karar verilebilir.

Keywords

Medulla oblongata, spinal cord, meningitis, oedema, tuberculomas

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