Kalsifiye nörosistiserkoz

Özet

Kalsifiye nörosistiserkoz, parankimde dejenerasyona uğramış Taenia solium larva odaklarının küçük mineralize nodüller olarak kaldığı enfeksiyon sekeli biçimidir. Kontrastsız BT bu nodülleri saptamada en duyarlı yöntemdir; eşlik eden ödem, nöbet odağı veya canlı kist şüphesi için MR tamamlayıcı bilgi sağlar. Tek bir kalsifiye odak bile nöbetle ilişkili olabilir; ventriküler ve bazal sisternal hastalık ise BOS akımını etkileyebilir. Nodülleri yalnızca tesadüfi kalsiyum kabul etmek, eşlik eden aktif veya ekstraaksiyel hastalığın araştırılmasını geciktirebilir.

Faz ve pencere

Kontrastsız tanısal

Parankimde küçük, yüksek yoğunluklu kalsifiye granülomlar seçilir. Çevre parankimde ödem düşük atenüasyonla görülebilir; ödem ve skoleksin değerlendirilmesinde MR daha duyarlıdır.

Önerilen pencereler: Beyin (G 80 / M 40), Kemik (G 1800 / M 400).

BT bulguları

• Serebral parankimde iyi sınırlı, yüksek atenüasyonlu kalsifiye nodül veya nodüller
• Kalsifiye granülomlar görüntülemede noktasal kalsifikasyonlar şeklinde izlenebilir.
• Kalsifiye granülom çevresindeki fokal düşük atenüasyonlu ödem olasılığı
• Birden fazla lobda dağılmış odakların aynı incelemede sayısı ve konumu
• Ventrikül genişlemesi veya BOS yolunda tıkanıklığa işaret eden bulgular aranır.
• Bazal sisternlerde silinme ya da kitle etkisi oluşturan eşlikçi hastalık
• Önceki BT ile karşılaştırmada kalsifiye odakların değişmeden kalması

Ölçütler ve sınıflamalar

Kalsifiye parankimal nörosistiserkozda tipik kalsifikasyon boyutu

Kalsifiye evre, görüntülemede noktasal kalsifikasyonlarla temsil edilir.

Nörosistiserkozun görüntüleme evreleri

Görüntüleme spektrumu canlı kistlerden dejenerasyona uğramış lezyonlara ve nihai kalsifiye granülom evresine uzanır; ekstraparankimal (racemoz) hastalık ventrikül içi veya bazal sisternlerde yerleşebilir.

Normalde

Aynı düzeyde normal BT'de korteks ile beyaz cevher arasında fokal yuvarlak, belirgin hiperdens bir nodül bulunmaz; ventriküller ve bazal sisternler açık olmalıdır. Nodül çevresindeki gri-beyaz cevher sınırını karşı hemisferle kıyaslayın ve ventrikül kalibresinin yerel parankim kaybı ya da BOS yolu tıkanıklığıyla değişip değişmediğine bakın.

Ayırıcı tanı

Tüberküloz granülomu, parankimal nörosistiserkozun ayırıcı tanısında yer alır.

Konjenital enfeksiyon sekeli

özellikle konjenital Zika sendromunda ince korteks ve subkortikal kalsifikasyonlar ile ilişkilidir.

Kavernom

kalsifikasyon eşlik edebilen bu lezyonda çevredeki kan ürünleri ve demir depolanması SWI gibi susseptibilite teknikleriyle belirgin şekilde izlenir.

Kalsifikasyon ve çevresel ödem birlikteyse oligodendrogliom ayırıcı tanıda düşünülebilir.

Sturge–Weber sendromu

noktasal nodül yerine tek taraflı giriform kortikal çizgiler ve hemisferik atrofi yapar

Tuzaklar

• Kalsifiye nodül çevresinde ödem BT'de sıklıkla tespit edilebilir; nöbet veya yeni nörolojik belirti durumunda MR ile çevresel reaksiyon ve eşlik eden lezyonlar detaylı olarak değerlendirilmelidir.
• İntraventriküler kistler BT'de BOS yoğunluğuna yakın olduğu için görünmeyebilir; hidrosefali şüphesinde incelemeyi normal kabul etmeyin.
• Kalsifiye granülomda ara sıra kontrastlanma olması canlı parazit bulunduğu anlamına gelmez; nodülün kalsifiye evresini diğer lezyonlardan ayırın.

Kendini dene

1. Endemik bölgede yaşayan hastanın kontrastsız BT'sinde birkaç küçük yoğun parankimal nodül saptanıyor. Kalsifiye evreyi en iyi hangi yorum açıklar?

   • Nonviable granülomlar
   • Akut metastazlar
   • Venöz malformasyonlar
   • Pineal kalsifikasyon
   Cevabı göster

   Nonviable granülomlar. Yoğun parankimal nodüller kalsifiye granülom evresiyle uyumludur. Kalsifiye granülomlar görüntülemede noktasal kalsifikasyonlar olarak izlenebilir ve kalsifiye nodüller aralıklı kontrastlanma gösterebilir.

2. Kalsifiye lezyonu olan hastalarda nöbet atağı sırasında perilesional ödem saptamak için hangi görüntüleme yöntemi klinik takipte kullanılır?

   • Manyetik rezonans (MR)
   • Kontrastsız BT
   • Direkt kafa grafisi
   • Beyin doppler US
   Cevabı göster

   Manyetik rezonans (MR). Perilesional ödem (PE) epizotları MR ile rutin takipte saptanabilir; BT de ödem sıklıkla gösterebilir (S1, S9).

İlgili konular

• Konjenital enfeksiyonlarda intrakraniyal kalsifikasyon

Kaynaklar

Bu sayfadaki 38 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 13 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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