Feng Y, Liu L, Zhang S
First Affiliated Hospital, Huaxi Medical University, Chengdu.
Zhonghua Jie He He Hu Xi Za Zhi. 1997 Jun;20(3):161-3.
To investigate the diagnosis of tuberculous meningitis.
One hundred twenty-nine cases of tuberculous meningitis proved by autopsy, from the year 1952 through 1994, were retrospectively reviewed.
Sixty-four cases were misdiagnosed before death, and the misdiagnosis rate was 49.6%. Among these misdiagnosed cases, 34 were misdiagnosed as other brain diseases, and the other 30 cases were misdiagnosed as severe pulmonary tuberculosis, severe pneumonia, gastric cancer, rheumatic heart disease, cor pulmonale and leukemia, etc. The main clinical manifestations included meningitis and extra-cerebral tuberculous syndromes. The cerebral spinal fluid changes included pressure increase, elevation of cell counts and protein content, decrease of glucose and chlorides. Both cerebral CT and intensified scan showed miliary tubercles in the brain parenchyma. High density stellate type of shadows in the basal surface of the brain, interpedunclar forsa and cerebral fissures, enlargement of brain ventricles, cerebral edema and thrombosis were also shown. Tuberculous lesions in the meninges, brain parenchyma, brain ventricles and brain blood vessels were found by autopsy.
The clinical manifestations, cerebral spinal fluid examination, in combination with CT scan of the head, and searching for extracerebral tuberculous foci are the basis for the diagnosis of tuberculous meningitis.
探讨结核性脑膜炎的诊断。
回顾性分析1952年至1994年间经尸检证实的129例结核性脑膜炎病例。
64例在死亡前被误诊，误诊率为49.6%。在这些误诊病例中，34例被误诊为其他脑部疾病，另外30例被误诊为重症肺结核、重症肺炎、胃癌、风湿性心脏病、肺心病和白血病等。主要临床表现包括脑膜炎和脑外结核综合征。脑脊液变化包括压力升高、细胞计数和蛋白质含量升高、葡萄糖和氯化物降低。脑部CT及强化扫描显示脑实质内有粟粒结节。还显示脑基底表面、脚间池和脑沟内有高密度星状阴影、脑室扩大、脑水肿和血栓形成。尸检发现脑膜、脑实质、脑室和脑血管有结核病变。
临床表现、脑脊液检查、结合头部CT扫描以及寻找脑外结核病灶是诊断结核性脑膜炎的依据。
