Kawajiri K, Matsuoka Y, Shen P H, Kanai M
Department of Neurosurgery, Saiseikai Ibaraki Hospital, Osaka, Japan.
No Shinkei Geka. 1989 Jun;17(6):589-92.
A case of hydrocephalus secondary to tuberculous meningitis is reported. A 6-month-old baby was admitted to our hospital with a 10-day history of high fever. Neurological examination revealed no abnormal findings other than neck stiffness. Cerebrospinal fluid findings suggested tuberculous meningitis, because of pleocytosis (608/mm3, 100% lymphocytes) and reduced sugar content (19 mg/dl). Mycobacterium tuberculosis was found in cerebrospinal fluid culture. Although anti-tuberculous therapy was administered for 2 weeks, deterioration of consciousness and papilledema appeared. CT scan demonstrated enlargement of the entire ventricular system, indicating communicating hydrocephalus. After a ventricular drainage was performed, consciousness disturbance improved, but the high fever persisted. Judging by cerebrospinal fluid findings, the meningitis seemed to be in the active stage. Therefore an Ommaya reservoir was installed instead of a cerebrospinal fluid shunt for fear of disseminating the tuberculous infection through the shunt tube. However, the hydrocephalus was not well controlled. Consequently, a ventriculoperitoneal shunt was placed, despite the fact that the disease was still active. The fever then gradually subsided, and cerebrospinal fluid findings normalized. The patient was discharged without any neurological deficits one month after emplacement of the ventriculoperitoneal shunt. The antituberculous therapy has been continued, and there is no sign of infection propagated through the shunt 13 months following discharge from the hospital. The result suggests that a cerebrospinal fluid shunt can be placed for hydrocephalus even in the active stage of tuberculous meningitis under antituberculous therapy.
报告了一例结核性脑膜炎继发脑积水的病例。一名6个月大的婴儿因持续10天的高烧入住我院。神经系统检查除颈部僵硬外未发现异常。脑脊液检查结果提示为结核性脑膜炎，因为有细胞增多（608/mm³，100%淋巴细胞）和糖分降低（19mg/dl）。脑脊液培养发现结核分枝杆菌。尽管给予抗结核治疗2周，但意识障碍和视乳头水肿仍出现。CT扫描显示整个脑室系统扩大，提示交通性脑积水。进行脑室引流后，意识障碍有所改善，但高烧持续。根据脑脊液检查结果判断，脑膜炎似乎处于活动期。因此，由于担心通过分流管传播结核感染，安装了Ommaya储液囊而非脑脊液分流器。然而，脑积水并未得到很好的控制。因此，尽管疾病仍处于活动期，还是进行了脑室腹腔分流术。随后体温逐渐下降，脑脊液检查结果恢复正常。脑室腹腔分流术后1个月，患者出院时无任何神经功能缺损。抗结核治疗一直在继续，出院13个月后没有通过分流传播感染的迹象。结果表明，在抗结核治疗下，即使在结核性脑膜炎的活动期，也可以为脑积水放置脑脊液分流器。
