Tuberculous meningitis.

To evaluate modern treatment and identify important factors influencing the outcome of tuberculous meningitis, clinical and laboratory findings in 52 patients aged from 9 months to 68 years have been reviewed. Patients were classified by clinical criterions at admission and at the start of treatment. Delay in commencing treatment was associated with deterioration and consequently poorer prognosis, but some severely ill patients made a good recovery. Forty-four survivors (85%) recovered, and only two patients (4%) had severe residual disability; eight (15%) of the patients died. Treatment should commence as soon as possible on clinical grounds without necessarily waiting for demonstration of Mycobacterium tuberculosis, as the organism can often be demonstrated in CSF withdrawn after the start of drug therapy.     

Tuberculous meningitis in the elderly.

Six cases of tuberculous meningitis, all occurring in patients over the age of 65, are described. All patients presented with an acute illness, primarily with a confusional state. Headache was a symptom in only two patients and the cases were not confined to ethnic minority groups. The mortality was 50%.     

结核性脑膜炎和新型隐球菌性脑膜炎合并脑梗死36例分析

目的探讨结核性脑膜炎和新型隐球菌性脑膜炎合并脑梗死患者临床表现、脑脊液和影像学的差异。方法回顾性分析2种慢性脑膜炎并发脑梗死的治疗、临床特点、脑脊液、影像学及预后。结果结核性脑膜炎并发的脑梗死多急性起病,多有抽搐、肢体瘫痪及意识障碍,病理征阳性,伴有颅外的表现,影像学伴有脑膜强化、结核瘤和脑积水,腺苷脱氢酶增高明显(P<0.05)。而隐球菌性脑膜炎多呈亚急性或慢性起病,以逐渐加重的头痛、呕吐为主要表现,意识障碍多为阵发性,很少有颅外表现,视乳头水肿明显,脑脊液压力高且细胞数明显增多(P<0.05),影像学表现为弥漫性脑肿胀可伴有脑积水,预后极差。结论两种脑膜炎一旦合并脑梗死预后差,致残率高;影像学和脑脊液的检查为二者的鉴别提供了客观依据。     

Tuberculous meningitis due to Mycobacterium bovis: a report of two cases

Two Caucasian patients with bovine tuberculous meningitis are described. Classical Mycobacterium bovis was isolated from the cerebrospinal fluid on both occasions. Despite the elimination of cattle tuberculosis in this country, reactivated primary disease due to the bovine tubercle bacillus may still occur.     

小儿结核性脑膜炎合并低钠血症44例临床分析

目的 分析小儿结核性脑膜炎合并低钠血症的临床表现及治疗效果,为探讨临床有效、安全的治疗方法 提供参考.方法 回顾性调查我院儿科1983年10月-1993年6月收治结核性脑膜炎合并低钠血症患者44例,进行临床疗效分析.结果 按照结核性脑膜炎合并低钠血症的诊断标准收集到44例患者,年龄在6个月～12岁.其中,男24例,女20例;结核性脑膜炎18例,结核性脑膜脑炎26例.采用限水、补钠及利尿等疗法.治疗效果为治愈32例(72.7%),好转10例(22.7%),死亡2例(4.5%).结论 小儿结核性脑膜炎合并SIADH引起的稀释性低钠血症临床上较常见,应引起足够重视,及时诊治.