Lan S H, Chang W N, Lu C H, Lui C C, Chang H W
Departments of Neurology, Chang Gung Memorial Hospital Kaohsiung, Kaohsiung, Taiwan.
QJM. 2001 May;94(5):247-53. doi: 10.1093/qjmed/94.5.247.
Twenty-eight patients with cerebral infarction secondary to chronic meningitis were retrospectively identified at our institution over a period of 5 years. They accounted for 47% (17/36) of tuberculous meningitis (TBM) and 32% (11/34) of cryptococcal meningitis cases. Single infarctions were found in 15 patients and multiple infarctions in 13. The distribution of single infarctions was: basal ganglia 7; internal capsule 3; thalamus 1; cerebellum 1; and cortical infarct 3. Therapeutic outcomes at 3 months were determined using a modified Barthel INDEX: At follow-up of 3 months or more, 10 had good outcomes while the other 18 had poor outcomes. The 18 with poor outcomes included six who died, and 12 who had severe neurological sequelae. TBM and cryptococcal meningitis shared similar clinical features, both being frequently associated with other neurological complications, including hydrocephalus, cranial nerve palsy, and seizures in our patients. However, extracranial involvement, such as spinal and pulmonary involvement, was more commonly found in TBM patients. Cerebral infarction can occur in both the acute stage and later stages of treatment. Mortality and morbidity are high, and early diagnosis and appropriate antimicrobial treatment are essential. If hydrocephalus is demonstrated, early ventricular decompression is needed to prevent further cerebral ischaemia.
在5年时间里，我们机构共回顾性确诊了28例继发于慢性脑膜炎的脑梗死患者。这些患者占结核性脑膜炎（TBM）病例的47%（17/36），占隐球菌性脑膜炎病例的32%（11/34）。15例患者为单发梗死，13例为多发梗死。单发梗死的分布情况为：基底节区7例；内囊3例；丘脑1例；小脑1例；皮质梗死3例。采用改良巴氏指数评估3个月时的治疗效果：在随访3个月及以上时，10例患者预后良好，其余18例预后不良。18例预后不良的患者中，6例死亡，12例有严重神经后遗症。TBM和隐球菌性脑膜炎具有相似的临床特征，在我们的患者中，二者均常伴有其他神经并发症，包括脑积水、脑神经麻痹和癫痫发作。然而，TBM患者更常出现颅外受累，如脊髓和肺部受累。脑梗死可发生在治疗的急性期和后期。死亡率和发病率都很高，早期诊断和适当的抗菌治疗至关重要。如果证实存在脑积水，则需要早期进行脑室减压以防止进一步的脑缺血。
