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结核性脑膜炎(结脑)非典型病例近年渐增多,易误诊。为提高对本病的认识,现将误诊的42例作一回顾分析。临床资料本组42例,男25例,女17例。年龄11～61岁,平均35岁。误诊与确诊情况1.以颅内高压起病误诊为脑脓肿、脑占位病变、脑干脑炎14例。发病缓慢,病程较长,7例达8个月以上,以头痛、呕吐,视乳头水肿为主要表现10例;视力障碍4例,脑膜刺激症状缺如或不明显4例;有偏瘫3例;颅神经损害定位症状或共济失调3例。大部分病史不全或体检遗漏。均以头痛、呕吐,视乳头水肿或视力障碍而入院。外科创伤检查无发现,病史查体启示,如不规律发热史,发现脑外结核和脑膜刺激征,脑脊液(CSF)检查14例均符合结脑,14例抗结核治疗显效。
Tuberculous meningitis (tuberculous meningitis) atypical cases increased in recent years, easily misdiagnosed. In order to improve the understanding of the disease, 42 cases of misdiagnosis will now be analyzed retrospectively. Clinical data The group of 42 patients, 25 males and 17 females. Age 11 to 61 years old, average 35 years old. Misdiagnosis and diagnosis 1. Intracranial hypertension misdiagnosed as brain abscess, brain space lesions, 14 cases of brainstem encephalitis. Slow onset, longer course of disease, 7 cases of up to 8 months or more, with headache, vomiting, papilledema as the main manifestation of 10 cases; 4 cases of visual impairment, meningeal irritation or absence of obvious or 4 cases; hemiplegia in 3 cases; Cranial nerve lesions or ataxia symptoms in ataxia in 3 cases. Most of the medical history or omission. All were headache, vomiting, papilledema or visual impairment and admission. Surgical trauma examination found no history of physical examination instruct, such as irregular fever, found that extracranial tuberculosis and meningeal irritation, cerebrospinal fluid (CSF) examination of 14 cases are consistent with brain, 14 cases of anti-TB treatment was effective.