小脳結核腫の1例

A Case of Cerebellar Tuberculoma

Ⅰ．はじめに

　頭蓋内結核腫は，多くは肺結核からの血行性転移により主に脳底槽や脳実質に形成される^{2,21, 23,25)}．頭蓋内結核腫は血液検査では異常を示さないことが多く，また髄液培養や髄液PCR（polymerase chain reaction）法での検出率も確実ではなく，いずれも決定的な所見はない^17,20,23)．先進国では比較的稀な疾患であったが，近年，後天性免疫不全症候群（AIDS）に伴う日和見感染症として注目されるようになり，今後ますます増加することが予想される^2,4,22,23)．今回われわれは，頭痛で発症し診断に至る特徴的な検査所見を認めず，診断に苦慮した成人小脳結核腫を経験したので若干の文献的考察を加え報告する．

We report a case of cerebellar tuberculoma presenting with headache,without any specific data. A 22-year-old male had headache for recent three months. Because of detection of the tubercle bacillus in his sputum,he was suspected the pulmonary tuberculosis and the tuberculous meningitis. On admission the cerebrospinal fluid revealed no abnormal data and the tubercle bacillus was not detected in the culture. We started medication for the tuberculosis. MRI demonstrated a mass lesion at the right cerebellum,suggesting the presence of a tuberculoma. He underwent total removal of the tumor via the supracerebellar route. Histological examination revealed tuberculoma when there are no abnormal data. The intracranial tuberculoma may be confused with an intracranial neoplasm. It is important to make an overall evaluation to diagnose tuberculosis ; for instance,compromised high age,HIV,and the type of steroid administered,will increase intracranial tuberculoma. In this report,we describe a cerebellar tuberculoma without any abnormal data,suggesting that intracranial tuberculoma should be considered in the differential diagnosis of any intracranial mass lesion.