Boissonnas A, Gaudouen C, Sereni D, Sicard D, Christoforov B, Modai J, Cremer G A, Pequinot H, Laroche C
Ann Med Interne (Paris). 1984;135(7):507-11.
The aim of this study was to determine the value of paraclinical investigations in the diagnosis of 32 adults with TB meningitis. Mycobacterium tuberculosis was found in spinal fluid cultures of 21 patients (66 p. 100). But only two had positive smears. In five with positive cultures the sampling was performed between one and 13 days after the beginning of chemotherapy. In 7 patients with negative spinal fluid cultures, mycobacterium tuberculosis was found in gastric contents aspiration (3); urine (2); bone marrow (1) and abscess (1). Cytochemical analysis of first spinal fluid samples showed an elevation of protein from 0.5 to 7 g/l in all patients (mean 2.1 +/- 1.6 g/l); sugar was low in 26 (mean 0.30 +/- 0.26 g/l); cell count was less than 500/mm3 in 26, with a mononuclear response in 24. 20 patients had lymphocytic and hypoglycorrachic meningitis. Cytochemical findings were independent of the delay between the first clinical symptoms and lumbar puncture. A. C. T. scan of the brain was performed in 8 patients with neurologic complications. Hydrocephalus was found in 3, and after the injection of contrast material, focal high-density areas in the basal cistern and the sulci of the cerebrum were observed in 2. Chest X ray showed miliary TB in 13 patients; but positive skin test for tuberculosis and hyponatremia were rarely helpful. To confirm adult tuberculous meningitis, we suggest that two spinal fluid samplings are necessary, but mycobacterium tuberculosis must be looked for simultaneously in the sputum, gastric contents, urine and bone marrow. Specific treatment can be started immediately after the first spinal fluid sampling. Chest X ray may be helpful, but C.T. scan of the brain and tuberculin test are of no value.
本研究的目的是确定辅助临床检查在32例成人结核性脑膜炎诊断中的价值。21例患者（66%）的脑脊液培养中发现结核分枝杆菌。但只有两例涂片呈阳性。5例培养阳性患者的样本采集是在化疗开始后的1至13天之间进行的。7例脑脊液培养阴性的患者中，在胃内容物抽吸物中发现结核分枝杆菌3例；尿液中2例；骨髓中1例；脓肿中1例。对首次脑脊液样本进行细胞化学分析显示，所有患者的蛋白质水平从0.5克/升升高至7克/升（平均2.1±1.6克/升）；26例患者血糖较低（平均0.30±0.26克/升）；26例患者的细胞计数低于500/mm³，其中24例呈单核细胞反应。20例患者患有淋巴细胞性和低血糖性脑膜炎。细胞化学检查结果与首次临床症状和腰椎穿刺之间的间隔时间无关。8例有神经系统并发症的患者进行了脑部CT扫描。3例发现脑积水，2例在注射造影剂后，在基底池和大脑沟回处观察到局灶性高密度区。胸部X线显示13例患者有粟粒性结核；但结核菌素试验阳性和低钠血症的诊断价值不大。为确诊成人结核性脑膜炎，我们建议进行两次脑脊液采样，但必须同时在痰液、胃内容物、尿液和骨髓中查找结核分枝杆菌。首次脑脊液采样后即可立即开始特异性治疗。胸部X线可能有帮助，但脑部CT扫描和结核菌素试验无诊断价值。
