结核性脑膜炎早期诊断和影响预后的因素

结核性脑膜炎早期诊断每易造成误诊,水文通过60例临床资料总结,认为寻找原发结核灶、csf细胞学检查、csf中ADA测定及动态观察csf改变均有助结脑的早期诊断。就诊晚、有抽搐昏迷,处于妊娠分娩期、老年患者及csf糖和氮化物含量明显降低者其预后均差。

INVESTIGATION ON EARLY DIAGNOSIS AND PROGNOSIS OF TUBERCULOUS MENINGITIS

This paper reports 60 cases with tuberculous meningitis hospitalized in the past 16 years.Among them 21,concurrently had extracerebral tuberculosis,15 had a history of exposure to tuberculous patients,29 were misdiagnosed as febrile illness and other infections of central nervous system.After antituberculous therapy 49 patients survived the disease,in whom 16 had some sequelae,such as deafness,limb paralysis,seizure,etc.,the following might be considered as the clues of early diagnosis,(1)a history of contact with tuberculous patients;(2)chest film revealed pulmonary shadous;(3)an increased amount of csf protein and a decreased level of csf glucose,chloride;(4)csf ell count ranges between 50-300mm~3 with a predominence of lymphocytes;(5)a strong positive OT test;(6)an increased activity of adenosine deaminase(ADA).Pregnancy,delivery,breast-feed and some chronic diseases may be the predisposing factors of tuberculous meningitis.It is desirable to diagnose and treat the patients as early as possible,because any delay in the treatment will invariably worsen the prognosis.