Kalita J, Misra U K
Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Acta Neurol Scand. 1999 Apr;99(4):225-31. doi: 10.1111/j.1600-0404.1999.tb07351.x.
The sensory and motor functions in severe tuberculous meningitis (TBM) may be difficult to assess clinically and may be helped by evoked potential studies. Lack of motor and somatosensory evoked potential studies in TBM prompted the present study.
All the patients with TBM underwent detailed neurological evaluation and cranial CT scan study. Motor and somatosensory evoked potentials to both upper and lower limbs were carried out bilaterally. The outcome was defined on the basis of 3 month Barthel Index (BI) score into good (BI > 12) and poor (BI < 12).
Forty-one highly probable patients with TBM whose ages ranged between 8 and 64 years and 14 of whom were females were included in this study. Twenty-three patients were in stage III (meningitis, neurological signs and altered sensorium), 12 in stage II (meningitis with neurological sign) and the remaining patients were in stage I (meningitis only). Cranial CT scan was carried out in all and MRI in 18 patients. On CT scan hydrocephalus was present in 21, infarction in 14 and tuberculoma in 4 patients. Motor evoked potential (MEP) was abnormal in 18 patients (36 limbs) and SEP in 9 patients (23 limbs). Upper limb central motor conduction time to abductor digiti minimi (CMCT-ADM) was abnormal in 15 and that to tibialis anterior (TA) in 21 limbs. CMCT abnormality was lateralized in 6 and only upper or lower limbs were involved in 11 patients. The SEP abnormalities were lateralized in 2 patients and only upper or lower limbs were involved in 3. The MEP changes correlated with stage of TBM and outcome whereas SEP with outcome only.
Motor and somatosensory evoked potentials may be helpful in objective documentation of respective motor and sensory functions in TBM patients with altered sensorium.
严重结核性脑膜炎（TBM）的感觉和运动功能在临床上可能难以评估，诱发电位研究可能有助于评估。TBM缺乏运动和体感诱发电位研究促使开展本研究。
所有TBM患者均接受详细的神经学评估和头颅CT扫描检查。双侧对上下肢进行运动和体感诱发电位检测。根据3个月的巴氏指数（BI）评分将结果定义为良好（BI>12）和差（BI<12）。
本研究纳入41例高度疑似TBM患者，年龄在8至64岁之间，其中14例为女性。23例患者处于Ⅲ期（脑膜炎、神经体征和意识改变），12例处于Ⅱ期（伴有神经体征的脑膜炎），其余患者处于Ⅰ期（仅脑膜炎）。所有患者均进行了头颅CT扫描，18例患者进行了MRI检查。CT扫描显示21例有脑积水，14例有梗死，4例有结核瘤。18例患者（36条肢体）运动诱发电位（MEP）异常，9例患者（23条肢体）体感诱发电位（SEP）异常。小指展肌（CMCT-ADM）上肢中枢运动传导时间异常的有15条肢体，胫前肌（TA）上肢中枢运动传导时间异常的有21条肢体。6例患者CMCT异常呈单侧性，11例患者仅累及上肢或下肢。2例患者SEP异常呈单侧性，3例患者仅累及上肢或下肢。MEP变化与TBM分期和结果相关，而SEP仅与结果相关。
运动和体感诱发电位可能有助于客观记录意识改变的TBM患者的各自运动和感觉功能。
