Muzumdar Dattatraya, Vedantam Rajshekhar, Chandrashekhar Deopujari
Department of Neurosurgery, King Edward VII Memorial Hospital, Parel, Mumbai, 400012, India.
Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India.
Childs Nerv Syst. 2018 Oct;34(10):1925-1935. doi: 10.1007/s00381-018-3884-9. Epub 2018 Jul 5.
Central nervous system tuberculosis (CNS TB) in children is still a socioeconomic problem in developing countries. It has varied manifestations, symptoms are nonspecific, diagnosis can be challenging, and treatment may be difficult. It is often missed or overlooked. Among the various pathological entities, tuberculous meningitis is the most common and devastating manifestation. The resultant vasculitis, infarction, and hydrocephalus can be life-threatening. It can have grave cognitive, intellectual, and endocrine sequelae if not treated in time resulting in handicap, especially in resource constraint countries. Early diagnosis and treatment of tuberculous meningitis is the single most important factor determining outcome. Tuberculous hydrocephalus needs to be recognized early, and cerebrospinal fluid diversion procedure needs to be performed in adequate time to prevent morbidity or mortality in some cases. Tuberculous pachymeningitis and arachnoiditis are rare in children. Tuberculous abscess can mimic pyogenic abscess and requires high index of suspicion. Calvarial tuberculosis is seen in children and responds well to antituberculous chemotherapy. Drug-resistant tuberculosis is a formidable problem, and alternate chemotherapy should be promptly instituted.
The pathogenesis, clinical features, diagnosis, and management of central nervous system tuberculosis in children are summarized.
Heightened clinical suspicion, early diagnosis, appropriate antituberculous treatment, and surgery in relevant situation are essential for a gratifying outcome and preventing complications.
在发展中国家，儿童中枢神经系统结核病（CNS TB）仍是一个社会经济问题。其表现多样，症状不具特异性，诊断具有挑战性，治疗可能困难，常被漏诊或忽视。在各种病理类型中，结核性脑膜炎是最常见且最具破坏性的表现。由此引发的血管炎、梗死和脑积水可能危及生命。若不及时治疗，会导致严重的认知、智力和内分泌后遗症，造成残疾，在资源有限的国家尤其如此。结核性脑膜炎的早期诊断和治疗是决定预后的唯一最重要因素。结核性脑积水需要早期识别，在适当的时候进行脑脊液分流手术，以防止在某些情况下出现发病或死亡。结核性硬脑膜炎和蛛网膜炎在儿童中罕见。结核性脓肿可类似化脓性脓肿，需要高度怀疑。儿童颅骨结核可见，对抗结核化疗反应良好。耐多药结核病是一个严峻的问题，应及时采用替代化疗方案。
总结儿童中枢神经系统结核病的发病机制、临床特征、诊断和管理。
提高临床怀疑度、早期诊断、适当的抗结核治疗以及在相关情况下进行手术，对于取得满意的治疗效果和预防并发症至关重要。
