Okuda Takeshi, Akai Fumiharu, Nakano Naoki, Uchiyama Takuya, Taneda Mamoru
Department of Neurosurgery, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan.
No To Shinkei. 2003 Jan;55(1):65-9.
A 40-year-old man with intractable meningitis was transferred to our hospital 6 weeks after onset. On admission, he showed consciousness disturbance, meningeal signs and right oculomotor nerve palsy. MRI demonstrated prominent cisternal enhancement and hydrocephalus. We suspected tuberculous meningitis as the diagnosis, and treated with antituberculotics, though he died of midbrain infarction day 11 of the treatment. Before and during the admission, bacterial cultures, PCR, smear examination of cerebrospinal fluid(CSF) were repeated. But no evidence of tuberculosis was obtained. Cultures of the brainstem fragments detected mycobacterium, which was finally confirmed by a PCR method after his death. PCR provides a rapid and reliable diagnosis of tuberculous meningitis, although there is a potential for false-negative. Thus the clinical, radiological and CSF findings should be stressed. Corticosteroids treatment should be considered in cases with ischemic lesions.
一名40岁患有顽固性脑膜炎的男性在发病6周后被转至我院。入院时，他出现意识障碍、脑膜刺激征及右侧动眼神经麻痹。磁共振成像（MRI）显示脑池明显强化及脑积水。我们怀疑诊断为结核性脑膜炎，并给予抗结核药物治疗，然而他在治疗第11天死于中脑梗死。入院前及入院期间，反复进行了脑脊液的细菌培养、聚合酶链反应（PCR）及涂片检查。但未获得结核病的证据。脑干组织碎片培养检测到分枝杆菌，其死后最终通过PCR方法得以确诊。尽管存在假阴性的可能性，但PCR可为结核性脑膜炎提供快速可靠的诊断。因此，应重视临床、影像学及脑脊液检查结果。对于有缺血性病变的病例，应考虑使用皮质类固醇治疗。
