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目的分析1例结核性脑膜炎(TBM)、脑脊髓膜炎合并多发性脑硬死病例,探讨发病原因及诊断,为临床诊治提供参考。方法根据病人临床症状、体征及既往患“系统性红斑狼疮”、“结核性脑膜炎”病史,结合实验室及影像学检查等综合诊断。结果病例主要诊断为“结核性脑脊髓膜炎合并多发性急性脑梗死”。颅内结核感染是病因之一。结论 TBM是最常见的肺外结核病,TBM和脑脊髓膜炎合并双侧颈内动脉系统多发性脑梗死少见,且脊髓膜炎所致脊髓橫贯性损害症状易掩盖脑梗死的体征,临床易漏诊,诊断应注意排除SLE脑病、脑炎和结核瘤的可能,可结合影像学检查进行鉴别诊断。
Objective To analyze a case of tuberculous meningitis (TBM), meningococcal meningitis combined with multiple brain injury cases, explore the causes and diagnosis, provide a reference for clinical diagnosis and treatment. Methods According to the patient’s clinical symptoms, signs and past history of “systemic lupus erythematosus”, “tuberculous meningitis” history, combined with laboratory and imaging studies such as comprehensive diagnosis. Results The main diagnosis was “Tuberculous meningitis with multiple acute cerebral infarction.” Intracranial tuberculosis infection is one of the causes. Conclusions TBM is the most common extrapulmonary TB disease. TBM and meningitis are rare in patients with multiple cerebral infarction of the bilateral internal carotid artery. Signs of spinal cord traumatic injury caused by meningitis may easily mask the signs of cerebral infarction. Misdiagnosis, diagnosis should be ruled out the possibility of SLE encephalopathy, encephalitis and tuberculosis can be combined with imaging examination for differential diagnosis.