Vikram Kushaal, Shivashankara K N, Chakraborty Joydeep, Umakanth Shashikiran
Department of Cardiology, GB Pant Hospital, New Delhi, India.
BMJ Case Rep. 2013 Aug 16;2013:bcr2013009841. doi: 10.1136/bcr-2013-009841.
Tuberculosis and malaria are two common diseases afflicting the population of the Indian subcontinent. Both are associated with fatal neurological complications. Clinically, it may be difficult to differentiate between the two, except for that the focal neurological complications are more common with central nervous system (CNS) tuberculosis than with cerebral malaria. We report the case of a 48-year-old woman who presented with a history of fever and altered sensorium of short duration. She was initially treated for falciparum malaria on the basis of positive peripheral smear and normal CT scan of the brain, but later on diagnosed to have CNS tuberculosis on the basis of persistence of symptoms, development of focal neurological symptoms and MRI of the brain showing multiple tuberculomas. She improved significantly with a course of antitubercular treatment (ATT) and systemic corticosteroids.
结核病和疟疾是折磨印度次大陆民众的两种常见疾病。两者都与致命的神经并发症相关。临床上，除了中枢神经系统（CNS）结核病比脑型疟疾更容易出现局灶性神经并发症外，可能很难区分这两种疾病。我们报告一例48岁女性病例，该患者有短期发热和意识改变病史。最初，根据外周血涂片阳性和脑部CT扫描正常，她被诊断为恶性疟，但后来基于症状持续存在、局灶性神经症状的出现以及脑部MRI显示多发结核瘤，被诊断为中枢神经系统结核病。经过抗结核治疗（ATT）和全身使用糖皮质激素治疗后，她病情明显好转。
