Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.
Department of Neurology, Haihe Clinical College of Tianjin Medical University, Tianjin, 300350, China.
BMC Neurol. 2023 Jun 24;23(1):245. doi: 10.1186/s12883-023-03286-4.
Tuberculous meningitis (TBM), complicated with cerebral venous thrombosis (CVT), has been sparsely reported and needs to be investigated further.
Among those with tuberculous meningitis in Haihe Hospital, Tianjin University, 3 patients with venous sinus thrombosis were identified retrospectively. "Tuberculous meningitis" and "cerebral venous thrombosis" were used as keywords, and the retrieved literature was summarized and analyzed. Our data were combined with previously reported case data to describe this new condition.
Among 28 patients with a median onset age of 31 years for TBM, 17 were females. The manifestations were fever, headache, and seizure. Magnetic resonance imaging (MRI) venography showed that the most common site of venous sinus thrombosis involved superior sagittal sinus, left transverse sinus, left sigmoid sinus, cavernous sinus, and straight sinus. The abnormalities found on MRI include hydrocephalus, exudates, hemorrhage, meningeal enhancement, infarction, and tuberculoma. In the acute phase, all patients received standard anti-TB treatment, and 14/28 patients received anticoagulant treatment. The mortality rate of these patients was 17.9%, and 21/28 (75%) became functionally independent.
CVT is one of the rare complications of TMB and must be considered a differential diagnosis in patients with TBM who show poor clinical features and/or develop new neurological signs.
结核性脑膜炎（TBM）并发脑静脉血栓形成（CVT）的报道较少，需要进一步研究。
在天津大学海河医院的结核性脑膜炎患者中，回顾性确定了 3 例静脉窦血栓形成患者。以“结核性脑膜炎”和“脑静脉血栓形成”为关键词，检索文献并进行总结分析。将我们的数据与以往报道的病例数据相结合，描述这种新的病症。
在 28 例 TBM 患者中，中位发病年龄为 31 岁，其中 17 例为女性。临床表现为发热、头痛和癫痫。磁共振成像（MRI）静脉造影显示，静脉窦血栓形成最常见的部位包括上矢状窦、左侧横窦、左侧乙状窦、海绵窦和直窦。MRI 发现的异常包括脑积水、渗出物、出血、脑膜强化、梗死和结核瘤。在急性期，所有患者均接受标准抗结核治疗，28 例中有 14 例接受抗凝治疗。这些患者的死亡率为 17.9%，28 例中有 21 例（75%）实现了功能独立。
CVT 是 TBM 的罕见并发症之一，对于表现不佳的临床特征和/或出现新的神经体征的 TBM 患者，必须考虑将其作为鉴别诊断。
