Department of Internal Medicine, Division of Infectious Diseases, Eastern Virginia Medical School, Norfolk, Virgina.
Am J Med Sci. 2014 Sep;348(3):186-90. doi: 10.1097/MAJ.0000000000000217.
Hypoglycorrhachia, a low glucose level in the cerebrospinal fluid (CSF), can suggest bacterial, fungal or tuberculous meningitis. When tests for these common infectious etiologies are negative, many clinicians are unsure of which diagnoses to consider, resulting in delayed treatment. The authors analyzed the diagnoses associated with hypoglycorrhachia to determine their relative frequencies at our institution and summarized all the diagnoses associated with hypoglycorrhachia in the literature.
Retrospective analysis of adults with hypoglycorrhachia at a tertiary care teaching hospital over a 5-year period. Inclusion criteria included CSF glucose <40 mg/dL and age 18 years or older. Exclusion criteria included CSF/serum glucose ≥0.6.
Eighty-nine unique hypoglycorrhachia episodes were identified. The most common etiologies among all episodes of hypoglycorrhachia were bacterial meningitis (24%), fungal meningitis (15%), stroke/bleed (13%), malignancy (11%), viral meningitis (6%), neurosarcoidosis (4%), neurosyphilis (4%) and cerebral toxoplasmosis (3%). The most common etiology was fungal meningitis (38%) among HIV-infected patients and bacterial meningitis (62%) among neurosurgery patients. However, in patients without HIV or neurosurgical history, noninfectious etiologies (stroke/bleed, 24%; malignancy, 22%) were most common.
Many diagnoses, both infectious and noninfectious, lead to hypoglycorrhachia and must be considered in the differential diagnosis.
脑脊液（CSF）中葡萄糖水平降低（低血糖症）可能提示细菌性、真菌性或结核性脑膜炎。当这些常见感染病因的检测结果为阴性时，许多临床医生不确定应考虑哪些诊断，从而导致治疗延误。作者分析了与低血糖症相关的诊断，以确定在我们机构中这些诊断的相对频率，并总结了文献中与低血糖症相关的所有诊断。
对一家三级保健教学医院 5 年内出现低血糖症的成年人进行回顾性分析。纳入标准包括 CSF 葡萄糖<40mg/dL 和年龄≥18 岁。排除标准包括 CSF/血清葡萄糖≥0.6。
共确定了 89 例低血糖症发作。低血糖症所有发作中最常见的病因是细菌性脑膜炎（24%）、真菌性脑膜炎（15%）、中风/出血（13%）、恶性肿瘤（11%）、病毒性脑膜炎（6%）、神经结节病（4%）、神经梅毒（4%）和脑弓形体病（3%）。在 HIV 感染患者中最常见的病因是真菌性脑膜炎（38%），在神经外科患者中最常见的病因是细菌性脑膜炎（62%）。然而，在没有 HIV 或神经外科病史的患者中，非传染性病因（中风/出血，24%；恶性肿瘤，22%）最常见。
许多诊断，包括感染性和非感染性病因，均可导致低血糖症，在鉴别诊断中必须考虑这些病因。
