[脑梗死与肺结核：病例报告及文献综述]
[Cerebral infarction and tuberculosis: case report and literature review].
作者信息
Tala-Ighil T, Greffe S, Trad S, Delaroche M, Coutte L, Rouveix E, Kahn J-E, Hanslik T
机构信息
Assistance Publique Hôpitaux de Paris, Service de médecine interne, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; Université de Versailles Saint Quentin, UFR Simone Veil, 78000 Versailles, France.
Assistance Publique Hôpitaux de Paris, Service de médecine interne, Hôpital Ambroise Paré, 92100 Boulogne Billancourt, France; Université de Versailles Saint Quentin, UFR Simone Veil, 78000 Versailles, France.
出版信息
Rev Med Interne. 2020 Oct;41(10):704-707. doi: 10.1016/j.revmed.2020.05.013. Epub 2020 Aug 27.
INTRODUCTION
Although tuberculous meningitis is an uncommon presentation of tuberculosis, it still remains one of the deadliest forms of this disease. In this context, the occurrence of a cerebral infarct is an aggravating factor.
OBSERVATION
A 48-year-old Asian man presented himself in the emergency room for dysarthria and dysphagia of progressive onset. Cerebral CT showed a recent ischemic defect of the right internal capsule. Lumbar puncture showed meningitis with low sugar levels. Pulmonary micronodules on the thoracic CT suggested tuberculosis, which was confirmed by a broncho-alveolar lavage. Anti-tuberculosis treatment and early corticosteroid resulted in an improvement of the patient's state.
CONCLUSION
Cerebral infarctions in patients with tuberculous meningitis are events that cannot be underestimated in terms of frequency or severity. Their poor prognosis is partly the result of insufficiently defined management, which combines anti-tuberculosis treatment and early corticosteroid therapy.
引言
尽管结核性脑膜炎是结核病的一种不常见表现形式，但它仍然是这种疾病最致命的形式之一。在这种情况下，脑梗死的发生是一个加重因素。
观察
一名48岁的亚洲男性因逐渐出现的构音障碍和吞咽困难而到急诊室就诊。脑部CT显示右侧内囊近期有缺血性缺损。腰椎穿刺显示为低糖水平的脑膜炎。胸部CT上的肺部微结节提示结核病，经支气管肺泡灌洗得以证实。抗结核治疗和早期使用皮质类固醇使患者病情有所改善。
结论
结核性脑膜炎患者发生的脑梗死，无论在发生率还是严重程度方面都不可低估。其预后不良部分是由于抗结核治疗和早期皮质类固醇治疗相结合的管理方式不够明确所致。
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