Kalsifiye nörosistiserkoz

Özet

Kalsifiye nörosistiserkoz, parankimde dejenerasyona uğramış Taenia solium larva odaklarının küçük mineralize nodüller olarak kaldığı enfeksiyon sekeli biçimidir. Kontrastsız BT rezidüel beyin kalsifikasyonlarını göstermede standart tarama incelemesidir; BT'de yalnız kalsifiye lezyon görülen bazı hastalarda MR canlı beyin kistlerini gösterebilir. Tek bir kalsifiye odak bile nöbetle ilişkili olabilir; ventriküler ve bazal sisternal hastalık ise BOS akımını etkileyebilir. Yalnız kalsifiye lezyon görünen bazı hastalarda BT'de saptanmayan canlı kistler bulunabilir, bu nedenle klinik kuşku varsa ek değerlendirme düşünülmelidir.

Faz ve pencere

Kontrastsız tanısal

Parankimde küçük, yüksek yoğunluklu kalsifiye granülomlar seçilir. Kalsifiye granülom çevresinde perilesional ödem görülebilir ve BT'de saptanabilir.

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
• Aynı incelemede odakların sayısı ve konumu kaydedilir.
• Ventrikül genişlemesi veya BOS yolunda tıkanıklığa işaret eden bulgular aranır.
• Eşlikçi ekstraparankimal hastalık kuşkusunda ventriküler genişleme ve bazal membran kalınlaşması aranır.
• Önceki BT ile karşılaştırmada kalsifiye odakların boyut ve görünüm değişikliği değerlendirilir.
• Kalsifiye parankimal nörosistiserkoz görüntülemede noktasal kalsifikasyonlar şeklinde izlenebilir; nöbet yinelemesi sırasında lezyon çevresinde ödem ve kontrastlanma görülebilir ve bu birliktelik reaktivasyonu düşündürebilir.

Ölçütler ve sınıflamalar

Kalsifiye parankimal nörosistiserkozda tipik kalsifikasyon boyutu

Kalsifiye evre, görüntülemede noktasal kalsifikasyonlarla temsil edilir.

Nörosistiserkozun görüntüleme evreleri

Kalsifiye granülomlar nörosistiserkozun son nodüler-kalsifiye evresini temsil eder; hastalık parankimal veya ekstraparankimal (racemoz) biçimde görülebilir.

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.

Sturge–Weber sendromunda kortikal kalsifikasyonlar ve ilerleyici beyin atrofisi görülebilir.

Tuzaklar

• Nöbet yinelemesi olan çocuklardan oluşan bir kohortta perilesional ödem BT'de saptanmıştır; başka bir çalışmada MR, semptom düşündüren durumlarda ve rutin takipte kullanılmıştır.
• İntraventriküler kistler BT'de BOS yoğunluğuna yakın olduğu için görünmeyebilir; hidrosefali şüphesinde incelemeyi normal kabul etmeyin.
• Kronik kalsifiye nodüller aralıklı kontrastlanabilir; nodülün kalsifiye evresini diğer lezyonlardan ayırın.

Kendini dene

1. Kalsifiye nörosistiserkozun son nodüler-kalsifiye evresi görüntülemede nasıl tarif edilir?

   • Noktasal kalsifikasyonlar
   • Canlı kistler
   • Yalnızca ventrikül genişlemesi
   • Bazal sisternlerde racemoz kistler
   Cevabı göster

   Noktasal kalsifikasyonlar. Kalsifiye granülomlar son nodüler-kalsifiye evreyi temsil eder ve görüntülemede noktasal kalsifikasyonlar olarak izlenir.

2. BT'de yalnız kalsifiye nörosistiserkoz görülmesine rağmen canlı kist kuşkusu sürüyorsa, BT'de gözden kaçabilen canlı kistleri değerlendirmek için hangi yöntem tamamlayıcıdır?

   • Manyetik rezonans (MR)
   • Direkt kafa grafisi
   • Beyin Doppler ultrasonografisi
   • Elektroensefalografi
   Cevabı göster

   Manyetik rezonans (MR). BT'de canlı kist saptanmayan bazı hastalarda MR incelemesinde canlı beyin kistleri görülmüştür.

İlgili konular

• Konjenital enfeksiyonlarda intrakraniyal kalsifikasyon

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 13 cümle bu karşılaştırmada düzeltildi (2026-10-10).

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