Lammie G Alistair, Hewlett Richard H, Schoeman Johan F, Donald Peter R
Department of Pathology, Cardiff University, Heath Park, Cardiff CF144XN, UK.
J Infect. 2009 Sep;59(3):156-66. doi: 10.1016/j.jinf.2009.07.012. Epub 2009 Jul 25.
Cerebrovascular complications of tuberculous meningitis are common, and may represent its most serious legacy. They present in clinically diverse ways, and continue to develop during the initial stages of treatment. Magnetic resonance imaging is the imaging modality of choice in detecting brain infarcts, typically revealing multiple or bilateral lesions in the territories of the middle cerebral artery perforating vessels. Vessel pathology appears to be a consequence of its immersion in the local inflammatory exudate. Infiltrative, proliferative and necrotising vessel pathologies have been described, but the relative contributions of each and of luminal thrombosis to brain damage remain unclear. There is some evidence that vasospasm may mediate strokes early in the course of the disease and proliferative intimal disease later strokes. Anti-tuberculous chemotherapy appears to be relatively ineffective in preventing vascular complications, perhaps suggesting an immune mechanism. However, a preventive role for corticosteroids remains to be proven. Study of the molecular pathogenesis of TBM vasculopathy is in its infancy. This review focuses in particular on pathogenetic aspects of tuberculous cerebrovascular disease, with a view to its future targeted prevention.
结核性脑膜炎的脑血管并发症很常见，可能是其最严重的遗留问题。它们以多种临床方式表现出来，并在治疗初期持续发展。磁共振成像（MRI）是检测脑梗死的首选成像方式，通常显示大脑中动脉穿支血管区域的多个或双侧病变。血管病变似乎是其浸入局部炎性渗出物的结果。已描述了浸润性、增殖性和坏死性血管病变，但每种病变以及管腔血栓形成对脑损伤的相对作用仍不清楚。有证据表明，血管痉挛可能在疾病早期介导中风，而增殖性内膜疾病则在后期介导中风。抗结核化疗在预防血管并发症方面似乎相对无效，这可能提示存在免疫机制。然而，皮质类固醇的预防作用仍有待证实。结核性脑膜炎血管病变的分子发病机制研究尚处于起步阶段。本综述特别关注结核性脑血管疾病的发病机制方面，以期未来进行有针对性的预防。
