Garg Ravindra Kumar, Sharma Rohitash, Kar Alok Mohan, Kushwaha Ram Avadh Singh, Singh Maneesh Kumar, Shukla Rakesh, Agarwal Atul, Verma Rajesh
Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow 226003, Uttar Pradesh, India.
Clin Neurol Neurosurg. 2010 Apr;112(3):188-92. doi: 10.1016/j.clineuro.2009.11.013. Epub 2009 Dec 23.
The symptomatic central nervous system involvement is often seen in patients with miliary tuberculosis.
In this study, we evaluated 60 consecutive miliary tuberculosis patients, who presented with some neurological manifestations. Evaluation included neurological examination, a battery of blood tests, HIV serology, sputum examination, cerebrospinal fluid (CSF) examination along with imaging of the brain and spinal cord. The patients were followed up after completion of 6 months of antituberculous treatment.
Patients ranged between 14 and 53 years in age. Three patients tested HIV positive. Forty-eight (80%) patients had tuberculous meningitis. In 12 (20%) patients, the CSF examination was normal. In 27 patients with tuberculous meningitis, neuroimaging revealed intracerebral tuberculoma. Fourteen patients showed multiple tuberculomas, while 7 had a solitary tuberculoma. In six patients, the tuberculomas were small and numerous. In two patients, neuroimaging revealed a spinal tuberculoma. For three patients with tuberculous brain masses, the CSF was normal. Nine (15%) patients presented with myelopathy. Three patients exhibited Pott's paraplegia. Three patients had transverse myelitis (with normal neuroimaging). In three patients, the spinal MRI revealed an intramedullary tuberculoma. On follow-up, 15 (25%) patients expired. Thirty-one (52%) patients showed significant improvement. Eight patients (13%) showed nil or partial recovery. Six of the patients with no improvement developed vision loss. Six (10%) patients were lost to follow up.
A variety of neurological complications were noted in military tuberculosis patients, tuberculous meningitis and cerebral tuberculomas being the most frequent complications. However, a majority of patients improved following antituberculous treatment.
粟粒性肺结核患者常出现有症状的中枢神经系统受累情况。
在本研究中，我们评估了60例连续的粟粒性肺结核患者，这些患者均有一些神经学表现。评估内容包括神经学检查、一系列血液检查、HIV血清学检查、痰液检查、脑脊液（CSF）检查以及脑和脊髓成像。患者在完成6个月抗结核治疗后进行随访。
患者年龄在14岁至53岁之间。3例患者HIV检测呈阳性。48例（80%）患者患有结核性脑膜炎。12例（20%）患者的脑脊液检查正常。在27例结核性脑膜炎患者中，神经影像学显示脑内结核瘤。14例患者显示多发结核瘤，7例有单个结核瘤。6例患者的结核瘤小且数量多。2例患者神经影像学显示脊髓结核瘤。3例患有结核性脑肿块的患者脑脊液正常。9例（15%）患者出现脊髓病。3例患者表现为波特氏截瘫。3例患者患有横贯性脊髓炎（神经影像学正常）。3例患者脊髓MRI显示髓内结核瘤。随访时，15例（25%）患者死亡。31例（52%）患者有显著改善。8例患者（13%）无改善或部分恢复。6例无改善的患者出现视力丧失。6例（10%）患者失访。
粟粒性肺结核患者出现了多种神经并发症，结核性脑膜炎和脑结核瘤是最常见的并发症。然而，大多数患者在抗结核治疗后有所改善。
