Cerebral fungal granuloma

Introduction to cerebral fungal granuloma Intracranial granuloma is not a new organism, but it is an intracranial space-occupying lesion, which also causes an increase in intracranial pressure and localized lesions. Therefore, it is not easy to distinguish from intracranial tumors before CT and MRI. Intracranial granuloma is a group of lesions, mostly due to chronic inflammation or various infections. In addition to fungal infections, it also includes cerebral tuberculosis, brain syphilis, various parasitic granulomas, such as cerebral schistosomiasis. Pneumococcal disease, serous protozoa, and sarcoidosis, xanthomatosis, eosinophilic granuloma, etc. Fungal infections are much less common than bacterial infections. basic knowledge The proportion of sickness: 0.003%-0.007% Susceptible population: can occur at any age, but 2/3 cases occur between 30 and 50 years old, more men than women. Mode of infection: non-infectious Complications: disturbance of consciousness hydrocephalus

Causes of cerebral fungal granuloma

Fungal infections (60%):

Fungal granuloma is a deep fungal infection, so any fungus that can cause deep tissue infection can be the pathogen of the disease, such as Cryptococcus neoformans, Aspergillus, Coccidioides, Coccidioides, Nocardia, Actinomycetes, capsular histoplasma, buds, molecular spores, candida, Poyd-like fungi, algae, etc., but cryptococcal, aspergillus and actinomycetes are more common, in recent years, Due to the widespread use of antibiotics, hormones and immunosuppressants in clinical practice, the promotion of organ tissue transplantation, and the increased awareness of fungal diseases among medical staff, the incidence of fungal infections has increased. In nature, fungi are widely distributed, and many fungi are Conditional pathogens, parasitic in the human body, when the body's resistance is reduced, they take advantage of the virtual, can invade the lungs, meninges and brain, spinal cord, skin, lymph nodes, intestines, liver, spleen, adrenal gland and other organs, fungal invasion The way of the brain is often inhaled from the respiratory tract, forming a lung lesion, which is then spread by the lungs through the blood to the whole body and into the skull. A few fungi (such as Aspergillus, actinomycetes and buds) can pass through the head. The lesions in the oral cavity, nasal cavity, paranasal sinus, eyelids, vertebrae, etc. directly invade the central nervous system. Individual cases can be worn through the lumbar region, surgically implanted to produce brain fungal infections, and mononuclear macrophage system malignant tumors. Patients with diabetes are more likely to develop this disease. Cryptococcus neoformans is the only pathogen of cryptococcus, has a special affinity for the central nervous system, and is the most common type of intracranial fungal infection.

Pathogenesis:

Fungi often invade the human body from the respiratory tract to form lesions, which are spread by the blood circulation to the brain and meninges. A few fungi such as mucor, actinomycetes can directly invade the meninges through facial features, skull and spinal bone lesions. Infection occurred through lumbar puncture.

Infection causes localized or extensive formation of irregular granuloma, lymphocytes, plasma cells or multinucleated giant cells infiltration, brain edema of varying degrees, fungi accumulate along the perivascular and subdural, forming most small cystic lesions , is an acute or chronic suppurative inflammatory reaction, and even forms a brain abscess or granuloma, mostly located in the brain parenchyma, occasionally inside the ventricle, a large number of fungal bodies or hyphae in the abscess and granuloma, different types of fungal infection, causing The pathological changes are also different. Candida albicans often causes small focal suppuration and granuloma. Cryptococcus forms jelly-like lesions in the early stage, no fibrous envelope, and granuloma forms in the late stage. Actinomycetes mainly form multiple abscesses and granuloma. The abscess wall is yellow, the pus contains "sulphur particles", and chronic brain disease often has extensive brain atrophy.

Brain fungal granuloma prevention

Proper use of antibiotics, hormones and immunosuppressive agents in the clinic should also actively prevent infection in patients with organ tissue transplantation and immune dysfunction.

Cerebral fungal granuloma complications Complications, disturbance of consciousness, hydrocephalus

A small number of large granulomas can produce corresponding signs of intracranial hypertension and focal neurological signs. In severe cases, there may be disturbances of consciousness, often with hydrocephalus.

Symptoms of cerebral fungal granuloma Common symptoms Increased intracranial pressure, low fever, high fever, nausea granuloma

The disease can occur at any age, but 2/3 cases occur in 30 to 50 years old, more men than women, slow onset or subacute, such as Cryptococcus neoformans and Aspergillus intracerebral infections are all in the upper respiratory tract (nasal cavity) Mucosa and lungs, disseminated by blood, most of the symptoms of the primary lesions are not obvious, that is, neurological symptoms, patients generally have low fever, occasionally high fever, the first symptoms are mostly headache, accompanied by nausea, vomiting, neck stiffness Such as meningeal irritation, the course of disease weeks to half a year, occasionally more than 1 year, a small number of cases may have remission and recurrence.

Examination of cerebral fungal granuloma

Cerebrospinal fluid pressure is normal or increased, the appearance is clear or slightly turbid, the number of white blood cells is mild to moderate (20-700)×106/L or more, mainly lymphocytes and neutrophils, protein content is increased, sugar content is reduced, chlorine Light to moderately reduced, generally not less than 85mmol / L, 50% ~ 80% of cases of cerebrospinal fluid ink staining can be seen with the capsular C. capsulatus, using enzyme-linked immunosorbent assay about 90% of the case serum or The capsular antigen can be detected in the cerebrospinal fluid, and the latex particle agglutination test has a relatively high specificity and is highly valuable in diagnosis.

CT scan

1 The basal and lateral fissures of the brain lose normal low density, and the density increases, which is occupied by exudates and is obviously strengthened;

2 cerebral arteritis causes cerebral infarction, showing a low density lesion;

3 meningeal adhesions caused by traffic or obstructive hydrocephalus;

4 basal ganglia and multiple cystic foci of the thalamus, no enhancement, specificity.

5 The granuloma in the parenchyma of the brain showed an equal or high-density image when scanned. After enhancement, it showed different sizes, multiple lesions, sharp borders, obviously enhanced nodules, or uneven enhancement, ring enhancement, surrounded by or Not accompanied by edema.

2. The T1 and T2 relaxation time of MRI scan brain basal pool is shortened, and it shows obvious enhancement after enhancement. It is in good contrast with low-signal brain tissue. The granuloma of brain parenchyma is equal or slightly lower on T2-weighted image. The signal, T2-weighted image, appears on the upper surface of the brain as a multi-shot, low signal with a diameter of about 5 mm.

Diagnosis and diagnosis of cerebral fungal granuloma

According to the clinical manifestations, the onset is slow, the course of disease is longer with meningeal irritation, increased intracranial pressure, etc., combined with other auxiliary examinations, can make a diagnosis, if the cerebrospinal fluid smear find fungus can be diagnosed.

The clinical manifestations and cerebrospinal fluid examination of this disease are similar to tuberculous meningitis, so cerebrospinal fluid examination and smear should be repeated, such as finding fungi to help differential diagnosis.

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