结核性脑膜炎患儿阵发性交感神经过度兴奋1例报告

目的探讨继发于结核性脑膜炎的阵发性交感神经过度兴奋病例的诊断及治疗。方法回顾性分析1例继发于结核性脑膜炎患儿的临床资料。结果患儿,男,1岁,因嗜睡、呕吐入院,脑膜刺激征阳性;脑脊液检查提示颅内感染,结核菌素(PPD)试验、结核感染T细胞斑点试验(T-SPOT.TB)和影像学检查提示结核性脑膜炎。治疗期间,患儿出现血压增高、心率增快、呼吸急促、肌张力异常和高热等阵发性交感神经过度兴奋;经普萘洛尔、安坦及氯硝安定治疗后改善。结论阵发性交感神经过度兴奋是结核性脑膜炎的少见表现,早期识别可以避免误诊和过度治疗。

Paroxysmal sympathetic hyperactivity in a child with tuberculous meningitis:a case study

Objective To report secondary paroxysmal sympathetic hyperactivity in a patient with tuberculous meningitis and to review the diagnostic criteria, clinical features, possible pathogenesis and management of this condition. Methods The clinical data of a case with paroxysmal sympathetic hyperactivity secondary to tuberculous meningitis was retrospectively analyzed and related literature was reviewed. Results A 1-year-old boy was admitted to our institute with a history of lethargy and vomiting for 3 days. Neurological examination revealed abnormalities. A lumbar puncture revealed the evidence of meningitis. PPD test, T-SPOT.TB and radiological examination revealed tuberculous meningitis. Later, when stayed in the intensive care unit, he developed paroxysmal hypertension, sinus tachycardia, tachypnea, dystonia, and high fever. These episodes improved after administration of propranolol, benzodiazepines and artane. Conclusions Paroxysmal sympathetic hyperactivity is a rare manifestation of tuberculous meningitis, early recognition is very important for avoid misdiagnosis and overtreatment.