论文部分内容阅读
目的探讨脑多发结核瘤的临床、脑脊液及病理特点在诊断中的价值及其治疗。方法回顾性分析我院神经内科2002年1月至2008年12月诊治脑多发结核瘤患者13例的临床资料。患者均行3次以上常规腰穿脑脊液检查、头颅CT及MRI检查。采取临床诊断(7例)和脑活检病理诊断(6例)。均予以抗结核治疗,其中6例行手术治疗。13例随访时间10个月至4.5年。结果患者症状多以发热、头痛急性起病,意识障碍4例,瘫痪4例,抽搐3例,脑膜刺激征8例,眼肌麻痹3例。脑脊液检查:压力升高10例,蛋白增高12例,糖减低9例,氯化物减低7例。脑脊液白细胞升高7例、正常6例,细胞学2例见混合性细胞反应,3例呈淋巴-单核细胞反应。头颅MRI均显示颅内多发结节或占位病变,增强提示强化,部分病例呈典型“环靶征”。6例开颅脑活检确诊为结核性肉芽肿。抗酸染色2例呈阳性。13例经过正规的抗结核治疗及手术治疗后,痊愈11例,死亡2例。结论脑脊液及MRI检查特点在脑多发结核瘤的诊断中具有重要地位,确诊依靠脑组织病理检查。一旦确诊应正规抗结核治疗,必要时行手术治疗。
Objective To investigate the value of clinical, cerebrospinal fluid and pathological features in the diagnosis of multiple brain tuberculosis in the diagnosis and treatment. Methods The clinical data of 13 cases diagnosed as multiple brain TB in our department from January 2002 to December 2008 were retrospectively analyzed. Patients underwent more than 3 times conventional lumbar puncture cerebrospinal fluid examination, head CT and MRI examination. Take clinical diagnosis (7 cases) and brain biopsy pathological diagnosis (6 cases). All were given anti-TB treatment, including 6 cases of surgical treatment. Thirteen patients were followed up for 10 months to 4.5 years. Results The symptoms of patients were fever, headache acute onset, disturbance of consciousness in 4 cases, paralysis in 4 cases, convulsion in 3 cases, meningeal irritation in 8 cases and ocular muscle paralysis in 3 cases. Cerebrospinal fluid examination: elevated pressure in 10 cases, 12 cases of increased protein, sugar decreased in 9 cases, chloride decreased in 7 cases. Cerebrospinal fluid leukocytosis in 7 cases, 6 cases of normal, cytology in 2 cases of mixed cell response, 3 cases were lymphatic - mononuclear cell response. Head MRI showed multiple intracranial nodules or space-occupying lesions, enhanced prompt enhancement, some cases were typical “ring target sign.” Six craniotomy biopsy confirmed tuberculous granuloma. 2 cases of acid-fast staining were positive. Thirteen patients underwent formal anti-TB treatment and surgery, recovered in 11 cases and died in 2 cases. Conclusion The features of cerebrospinal fluid (CSF) and MRI examination play an important role in the diagnosis of multiple brain tuberculosis. The diagnosis depends on the pathological examination of brain tissue. Once the diagnosis should be formal anti-TB treatment, if necessary, surgical treatment.