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目的 :探讨老年结核性脑膜炎 (结脑 )并发中重度脑积水的临床特征 ,影像学改变与脑积水形成的关系。方法 :通过CT或MRI证实为脑积水的老年结脑 35例进行回顾性分析 ,与同期无脑积水的老年结脑 33例对照。结果 :老年结脑临床症状不典型 ,基础疾病多 ,病死率高 (5 1 42 % ) ,与对照组差异显著 (P <0 0 5 )。CT示脑积水重度 13例、中度 2 2例 ,脑室周围水肿与积水程度有关。大脑导水管梗阻占 82 85 % ,基底池粘连为 2 0 % ,结核瘤占 2 2 85 %。MRI对脑室周围水肿及脊髓病变有一定优势。脑积水与结脑复发、抗痨治疗的迟早、合并糖尿病、肺结核等因素有关。脑脊液蛋白定量、白蛋白、IgG显著高于对照组 (P <0 0 5 )。结论 :脑膜纤维蛋白渗出、增殖与老年性脑室变窄是形成脑积水的直接因素。CT与脑脊液蛋白指标的监测对脑积水早期诊断 ,预后评估具有重要价值。早期抗痨治疗是减少脑积水发生的关键
Objective: To investigate the clinical features, imaging changes and the formation of hydrocephalus in elderly patients with tuberculous meningitis (tuberculous meningitis) complicated with moderate and severe hydrocephalus. Methods: A retrospective analysis was performed on 35 cases of senile tuberculous meningitis confirmed by CT or MRI and compared with 33 cases of senile tuberculous brain without hydrocephalus in the same period. Results: The clinical symptoms of senile tuberculosis were not typical, with many underlying diseases and high mortality (5 1 42%), which were significantly different from the control group (P0 05). CT showed severe hydrocephalus in 13 cases, moderate in 22 cases, periventricular edema and water level. Cerebral aqueduct obstruction accounted for 82 85%, basal cell adhesion was 20%, tuberculosis accounted for 2 2 85%. MRI has certain advantages for periventricular edema and myelopathy. Hydrocephalus and knot brain recurrence, anti-tuberculosis treatment sooner or later, with diabetes, tuberculosis and other factors. Cerebrospinal fluid protein, albumin, IgG were significantly higher than the control group (P <0 05). Conclusion: The exudation and proliferation of cerebrum fibrin and the narrowing of senile ventricles are the direct factors of forming hydrocephalus. CT and CSF protein index monitoring of early diagnosis of hydrocephalus, prognostic evaluation of great value. Early anti-tuberculosis treatment is to reduce the occurrence of hydrocephalus