结核性脑膜炎合并脑结核瘤的临床特点

目的探讨结核性脑摸炎(TBM)合并脑结核瘤的临床特点,以提高对本病的认识和诊治水平。方法对我院2001年1月-2009年12月收治的TBM合并脑结核瘤患者26例的临床资料进行分析,探讨本病的临床特点。结果在TBM合并脑结核瘤时,出现各种脑局灶性损害体征。脑脊液多数呈TBM典型改变。11例在CT及MRI上呈现"靶征",CT发现结核瘤数2～14个,平均6.5±4.2个。MRI发现结核瘤数为2～17个,平均7.4±4.4个。临床治愈出院19例,好转4例,死亡3例。结论 TBM合并脑结核瘤的患者,临床表现复杂,如果出现局灶性脑损害体征,应考虑本病的可能。脑脊液检查不能提示脑结核瘤的存在与否,CT和MRI能显示脑结核瘤的部位、大小及数目等。尽早规范的抗结核综合性治疗,多数病人恢复良好。     

常规抗结核治疗联合异烟肼鞘内注射治疗结核性脑膜炎合并结核瘤的疗效观察(附3例报告)

目的观察常规抗结核治疗联合异烟肼鞘内注射治疗结核性脑膜炎合并结核瘤的疗效。方法回顾性分析3例结核性脑膜炎合并结核瘤患者经常规抗结核治疗联合异烟肼鞘内注射治疗后的临床表现、CSF及影像学改变。结果本组3例患者均亚急性起病,病程中或治疗过程中合并出现结核瘤,经常规抗结核治疗联合鞘内注射治疗(异烟肼0.1 g+地塞米松5 mg),临床症状缓解,CSF恢复正常,影像学示脑部病灶消失。结论对于结核性脑膜炎合并结核瘤来说,常规抗结核治疗联合异烟肼鞘内注射治疗也许是一个有效的治疗方案。     

脑脊液置换联合鞘内注射治疗结核性脑膜炎临床疗效评价

目的：评估脑脊液置换联合鞘内注射治疗结核性脑膜炎的临床效果。方法结脑患者64例随机分为对照组32例和观察组32例。对照组予以异烟肼、利福平、吡嗪酰胺、乙胺丁醇等抗结核治疗及地塞米松激素治疗。观察组在常规抗结核治疗的基础上加用脑脊液置换联合鞘内注入异烟肼,地塞米松,胞二磷胆碱等药物治疗。分别记录2组脑脊液转阴时间,临床症状消失时间,住院时间,观察周期3个月,比较2组疗效。结果观察组总有效率脑脊液转阴时间、临床症状消失时间、住院时间方面均明显优于对照组（ P＜0.05）。结论脑脊液置换联合鞘内注射治疗结核性脑膜炎可有效缓解结核性脑膜炎患者的临床症状,缩短疗程,临床效果显著。     

抗结核联合针刺治疗结核性脑膜炎后遗症23例临床分析

目的探讨抗结核药物联合针刺治疗结核性脑膜炎后遗症的临床疗效。方法 2003-02—2013-02我院诊治的46例结核性脑膜炎后遗症患者,根据随机数字法,分为对照组(常规抗结核药物治疗)和观察组(抗结核药物联合针刺治疗),每组23例,观察和比较2组临床疗效、脑脊液细胞恢复时间、蛋白恢复时间、不良反应。结果与对照组相比,观察组总有效率明显升高,脑脊液细胞恢复、蛋白恢复时间、不良反应发生率均显著减少,差异有统计学意义(P<0.05)。结论对于结核性脑膜炎后遗症患者,抗结核药物联合针刺治疗效果显著,明显提高患者的预后质量,值得临床推广。     

脑脊液置换联合鞘内注射治疗结核性脑膜炎疗效观察

目的观察脑脊液置换联合鞘内注射对结核性脑膜炎患者脑脊液生化的影响,并探讨其疗效。方法 128例结脑患者随机分为治疗组（n=65）和对照组（n=63）,对照组常规治疗,治疗组在常规治疗的基础上采用脑脊液置换联合鞘内注射,治疗结束后对2组疗效进行比较分析。结果治疗组在改善脑脊液生化指标方面均优于对照组（P〈0.05）。治疗组总有效率为96.72%,治愈率为65.57%;对照组总有效率为76.67%,治愈率为45.00%,差异有统计学意义（P〈0.01）。结论脑脊液置换联合鞘内注射治疗结核性脑膜炎疗效显著。     

脑脊液置换联合鞘内给药治疗结核性脑膜炎疗效观察

目的 观察脑脊液置换联合鞘内给药治疗结核性脑膜炎的临床疗效.方法 将37例结核性脑膜炎患者分为治疗组26例和对照组11例,对照组采用正规抗结核疗法,治疗组在其基础上加用脑脊液置换联合鞘内注药疗法.结果 治疗组治愈23例,治愈率为88.46%, 对照组治愈8例,治愈率72.72%, 2组的临床疗效之间差异有统计学意义(P＜0.05).结论 脑脊液置换联合鞘内给药法对结核性脑膜炎安全、有效,能明显提高治愈率.     

结核性脑膜炎脑脊液结核分枝杆菌抗原的动态变化分析

目的探讨结核性脑膜炎(结脑)脑脊液结核分枝杆菌(MTB)抗原的动态变化。方法对临床诊断为结脑及病毒性脑膜炎(病脑)的患者各30例进行脑脊液MTB抗原动态分析,分别于发病第1、2、4周进行脑脊液单核细胞MTB抗原免疫组织化学染色,进行阳性细胞计数并统计阳性病例数。结果结脑组第1周脑脊液MTB抗原阳性27例(90%),阳性细胞比例(22.6±1.6)%,第2周阳性27例(90%),阳性细胞比例(21.8±2.1)%,第4周阳性9例(30%),阳性细胞比例(10.5±1.1)%;第1、2周MTB抗原阳性率及阳性细胞比例明显高于第4周(P<0.01)。病脑组第1周MTB抗原阳性3例(10%),阳性细胞比例为(5.2±1.3)%,第2、4周检测结果均为阴性。结脑组第1周较病脑组MTB抗原阳性例数及阳性细胞比例明显升高(P<0.01)。MTB抗原检测早期结脑(发病2周内)敏感性、特异性均达90%。结论脑脊液MTB抗原检测有助于结脑的早期诊断。     

单纯性脑结核瘤的临床与CT

单纯性脑结核瘤的临床与ＣＴ赵建华，胡亚梅，冯周琴现将我科１９９０年至１９９３年间收治的１２例单纯性脑结核瘤的临床及ＣＴ资料分析报告如下，以供同道参考。１临床资料１．１一般资料共１２例，男１０例，女２例，年龄１４～６０岁，平均２６岁。１０例以癫痫起病，...     

Concurrent syringomyelia and intradural extramedullary tuberculoma as late complications of tuberculous meningitis

Tuberculous meningitis (TBM) is a common presentation of extrapulmonary tuberculosis. TBM is associated with many complications. However, concurrent syringomyelia and intradural extramedullary tuberculoma occurring in a patient treated for TBM is rare. Only one such case has been reported earlier. A 27-year-old woman presented with paraparesis of 2 months duration. She had been treated for TBM 8 months earlier. She was found to have an extensive syringomyelia from C2 to the conus medullaris and an intradural extramedullary tuberculoma at the lower thoracic levels. At surgery, a thick, granulomatous lesion was found in the intradural extramedullary plane. Following excision of the granulomatous lesion, a syringostomy was done. The patient was treated with antituberculous drugs and steroids. Six months after treatment, there was no significant change in her neurological status. Concurrent syringomyelia and intradural extramedullary tuberculoma should be entertained in the differential diagnosis when a patient presents with myelopathy following TBM. The pathogenesis of syringomyelia in this condition is discussed.     

Neurological complications of miliary tuberculosis

Introduction

The symptomatic central nervous system involvement is often seen in patients with miliary tuberculosis.

Materials and methods

In this study, we evaluated 60 consecutive miliary tuberculosis patients, who presented with some neurological manifestations. Evaluation included neurological examination, a battery of blood tests, HIV serology, sputum examination, cerebrospinal fluid (CSF) examination along with imaging of the brain and spinal cord. The patients were followed up after completion of 6 months of antituberculous treatment.

Results

Patients ranged between 14 and 53 years in age. Three patients tested HIV positive. Forty-eight (80%) patients had tuberculous meningitis. In 12 (20%) patients, the CSF examination was normal. In 27 patients with tuberculous meningitis, neuroimaging revealed intracerebral tuberculoma. Fourteen patients showed multiple tuberculomas, while 7 had a solitary tuberculoma. In six patients, the tuberculomas were small and numerous. In two patients, neuroimaging revealed a spinal tuberculoma. For three patients with tuberculous brain masses, the CSF was normal. Nine (15%) patients presented with myelopathy. Three patients exhibited Pott's paraplegia. Three patients had transverse myelitis (with normal neuroimaging). In three patients, the spinal MRI revealed an intramedullary tuberculoma. On follow-up, 15 (25%) patients expired. Thirty-one (52%) patients showed significant improvement. Eight patients (13%) showed nil or partial recovery. Six of the patients with no improvement developed vision loss. Six (10%) patients were lost to follow up.

Conclusion

A variety of neurological complications were noted in military tuberculosis patients, tuberculous meningitis and cerebral tuberculomas being the most frequent complications. However, a majority of patients improved following antituberculous treatment.     

Clinical and radiological features of symptomatic central nervous system tuberculomas

Tuberculomas may present with meningitis, may lead to meningitis, or may develop during the treatment of TBM. In this study, we report a series of 22 adult cases of symptomatic central nervous system tuberculomas, in eight of them tuberculomas were coexisting with TBM on admission and in 14 of them symptomatic tuberculomas developed during anti-tuberculosis therapy. We also aimed to compare the clinical, laboratory and outcome data of the 14 TBM patients that developed symptomatic tuberculomas, with the data of 41 TBM that did not, under the same treatment regimen. Most of the patients developed symptomatic tuberculomas in the first 6 weeks of treatment. Five patients developed late tuberculomas. The characteristics of tuberculomas and the role of corticosteroids in TBM patients are discussed. In conclusion, although steroids may diminish neurologic symptoms and improve outcome, tuberculomas may appear during the course of anti-tuberculosis and steroid treatment. Because of the possibility of late development of tuberculomas after initial successful treatment, all TBM patients need to be followed-up carefully for a long period.     

Appearance of tuberculoma during the course of TB meningitis

Summary A patient with tuberculous meningitis is described, who developed brainstem tuberculoma after 7 months of adequate drug therapy and while improving satisfactorily. The possible factors resulting in the development of tuberculoma are discussed. The tuberculoma responded to the medical therapy. Tuberculoma should be looked for if the condition of the patient worsens or if the patient develops new neurological signs during the course of TB meningitis.     

血栓通注射液治疗结核性脑膜炎临床观察

目的观察血栓通注射液治疗结核性脑膜炎的疗效和安全性。方法将43例结核性脑膜炎病例随机分为对照组(n=20)和治疗组(n=23),对照组予常规治疗,治疗组在常规治疗基础上加用血栓通注射液,500mg/d,疗程4周。结果治疗组显效率、总有效率均高于对照组(P<0.05),临床症状、体征、脑脊液常规、生化明显改善,且无明显不良反应。结论血栓通注射液治疗结核性脑膜炎可有效减轻临床症状,缩短疗程。     

结核性脑膜脑炎一例临床与病理分析

目的分析1例结核性脑膜脑炎的临床及病理特点。方法对该患者的临床、实验室检查及治疗过程进行描述,死亡后进行系统的病理解剖,光学显微镜下观察病变。结果早期未正规化治疗是造成病情加重的重要原因,其病变组织可见广泛干酪样坏死、Langhans细胞及多核类上皮细胞浸润。结论早期规范抗结核治疗是降低病死率、提高治愈率的关键。