Lesões múltiplas não neoplásicas na tomografia computadorizada do crânio

Abstract

Multiple intracranial lesions observed in the computerized tomography ever cause worry due to the possibility of neoplastic etiology, although granulomatous diseases (parasitic or not) and vascular diseases can produce this type of lesions. Five patients with clinical picture that suggested expansive intracranial masses and that had multiple lesions in the computerized tomography that suggested neoplastic diseases are presented. In all patients the clinical evolution and/or other complementary diagnostic tests showed the non neoplastic etiology of the lesions. In three patients the lesions were due to parasitic diseases (intracranial tuberculomas in one case and neurocysticercosis in two cases) and in the other two cases the lesions were due to vascular disturbs (cerebral infarcts). The knowledge of the several diseases that can cause multiple intracranial lesions as seen in the computerized tomography allows to direct the etiologic diagnostic that is essential to introduce the correct treatment avoiding irradiation of non neoplastic lesions and unnecessary surgical procedures. In our country, granulomatous parasitic diseases, mainly neurocysticercosis, tuberculosis and fungal diseases must be considered in the differential diagnosis of multiple intracranial lesions observed in the computerized tomography, together with cerebral infarcts and neoplasms.

Intramedullary spinal cord paracoccidioidomycosis: report of two cases

“…In the hypothesis of granulomas of the CNS, due to the high incidence of tuberculosis and blastomycosis in Brazil, these granulomas should be most frequently kept in mind". Exceptionally, when there is previous or current evidence of systemic disease, a granuloma of the nervous system should be the primary suspicion in the presence of signs and symptoms suggesting an intracranial or intraspinal expansive process 7,8,22 , as observed on both cases reported here.…”

“…The clinical manifestations of brain granulomas are nonspecific, reflecting an expansive process of slow evolution 7 . Intraspinal granulomas usually progress to a picture of spinal cord compression 4 -5 14 18,23,33 , which, due to the lack of space, may progress in a more rapid and severe manner.…”

“…Magnetic resonance images reveal an expansive process, but with no characteristics that might permit its specific diagnosis 33 . The hypothesis of a granuloma of the nervous system should be raised when multiple lesions are observed by computerized tomography 7 . In these cases, the evidence of pulmonary involvement by the disease, at time asymptomatic, may suggest the etiologic diagnosis.…”