Nozaki H, Koto A, Amano T, Tanahashi N, Tanaka K, Kobari M, Fukuuchi Y
Department of Neurology, School of Medicine, Keio University, Tokyo, Japan.
Kekkaku. 1997 Mar;72(3):139-46.
We evaluated the clinical features of 5 cases of tuberculous meningitis who had been admitted to our department from 1987 to 1994. Three patients were male and two were female. Their age ranged from 17 to 74 years old. All cases were examined by both CT and MRI before and during antituberculous treatment. Before the treatment, CT scan revealed abnormal findings such as nodular lesion suggesting tuberculoma, subarachnoid contrast enhancement or cerebral infarction in 2 cases, while MRI revealed abnormal findings such as inflammatory lesions with Gd-enhancement in 4 out of 5 patients. During the treatment, all abnormal findings except cerebral infarction disappeared. No abnormal findings were detected by CT. MRI and SPECT in one case who showed right hemiparesis and motor aphasia. In summary, CT scan could demonstrate abnormal findings in only a small portion of patients with tuberculous meningitis. One the other hand, MRI revealed various abnormal findings in most patients, and could reveal some lesions which could be responsible for the symptoms of patients. In a few patients, however, MRI could not show any lesion in spite of obvious focal neurological signs. MRI is considered to be useful for detecting the lesions in most patients with tuberculous meningitis, although its findings are not always specific for the disease.
我们评估了1987年至1994年间收治于我科的5例结核性脑膜炎患者的临床特征。3例为男性，2例为女性。年龄范围为17至74岁。所有病例在抗结核治疗前及治疗期间均接受了CT和MRI检查。治疗前，CT扫描显示2例有异常表现，如提示结核瘤的结节状病变、蛛网膜下腔强化或脑梗死；而MRI显示5例患者中有4例有异常表现，如钆增强的炎性病变。治疗期间，除脑梗死外的所有异常表现均消失。1例出现右侧偏瘫和运动性失语的患者，CT、MRI和SPECT均未检测到异常表现。总之，CT扫描仅能在一小部分结核性脑膜炎患者中显示异常表现。另一方面，MRI在大多数患者中显示出各种异常表现，且能揭示一些可能导致患者症状的病变。然而，在少数患者中，尽管有明显的局灶性神经体征，MRI却未显示任何病变。MRI被认为对大多数结核性脑膜炎患者的病变检测有用，尽管其表现并不总是对该疾病具有特异性。
