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目的:探讨边远地区成人结核性脑膜炎并发中、重度脑积水的临床特点与影像学变化。方法:回顾性分析经影像学证实的结核性脑膜炎并中、重度脑积水33例。结果:脑积水的形成与多项临床因素有关;脑积水组的脑压、细胞数低于无积水组,而蛋白质、腺苷脱氨酶高于无积水组;脑脊液蛋白质增高与脑积水形成有关;脑积水组中大脑导水管梗阻占57.5%,基底池粘连占42.4%。结论:脑膜纤维蛋白渗出、粘连是造成脑积水的主要原因。病人文化素质低、居住边远、就诊延误等因素影响预后。CT、MRI及脑脊液蛋白质指标的监测对脑积水的早期诊断、预后评估具有重要意义。
Objective: To investigate the clinical features and imaging changes of adult tuberculous meningitis complicated with moderate and severe hydrocephalus in remote areas. Methods: Retrospective analysis of 33 cases of tuberculous meningitis with moderate and severe hydrocephalus confirmed by imaging. Results: The formation of hydrocephalus was related to many clinical factors. The hydrocephalus group had lower intracerebral pressure and cell number than those without hydrocephalus, while the protein and adenosine deaminase were higher than those without hydrocephalus. Cerebrospinal fluid protein increased with brain Hydrocephalus formation; hydrocephalus brain aqueduct obstruction accounted for 57.5%, basal cell adhesion accounted for 42.4%. Conclusion: Membrane fibrin exudation and adhesion are the main causes of hydrocephalus. Low quality of patients with culture, remote living, delayed treatment and other factors affect the prognosis. CT, MRI and cerebrospinal fluid protein markers for the early diagnosis of hydrocephalus, prognosis of great significance.