Aseptic Meningitis

Outbreaks of aseptic meningitis like illnesses have occurred in high school football players for reasons that may include the close contact among players and the overlap of football season with the peak enterovirus season. The main symptoms are fever, headache, and neck or back stiffness; physical findings may include signs of meningeal irritation. Evaluation of the cerebrospinal fluid can confirm the diagnosis. Treatment of viral meningitis is generally supportive, and patients usually do well, while other forms of aseptic meningitis may require drug treatment or removal of inciting medications. Not sharing water bottles may help reduce risk.     

Meningitis in the athlete

Infectious diseases among athletic teams commonly present challenges for team physicians and primary care doctors. There is some evidence to suggest that athletes are more susceptible to infection during an outbreak of the general population. The frequent physical contact and close travel arrangements associated with many team sports may put athletes at even greater risk. Viral meningitis is the most commonly reported central nervous system infection in the literature, and transmission seems to be increased among U.S. high school football teams. Septic meningitis is a life-threatening emergency that can occur in outbreaks affecting populations frequently involved in organized athletics (adolescents and young adults). The purpose of this review is to identify current medical literature on the epidemiology, diagnosis, treatment, and prevention of meningitis in the athletic population.     

结核性脑膜炎的CT评价

目的　评价结核性脑膜炎（TBM）的CT表现和诊断作用。方法　对40例临床诊断为TBM的CT平扫和增强扫描进行了回顾性研究。结果　CT扫描36例（90%）显示异常,其他4例正常。CT扫描异常表现包括脑底渗出22例,脑积水36例,脑梗塞11例和结核瘤9例。结论　TBM的特征性CT表现为脑底池和外侧裂的炎性渗出,CT扫描对于观察TBM的脑积水、脑梗死和结核瘤等并发症也很重要,这些因素都和治疗计划相关。经过内科治疗以后,CT显示结核瘤持续存在或者进行性脑室扩张,应当考虑手术治疗。     

结核性脑膜炎的MRI表现

结核性脑膜炎(tuberculous meningitis , TBM) 是中枢神经系统常见的感染性疾病, 结核杆菌经血循环播散,侵入蛛网膜下腔引起脑膜结核性炎症,病变除累及软脑膜外,蛛网膜、脑实质、脑血管也常常受累.它在结核杆菌感染疾病中表现形式最严重,是结核病死亡主要原因之一,致残率高.早期准确诊断有助于临床及时、正确的治疗,但由于其早期临床表现特异性差,常被误诊.结核性脑膜炎患者的MRI表现具有一定的特征性,可为临床早期诊断及治疗提供可靠依据.本文回顾性分析在本院诊治的19例资料完整的结核性脑膜炎病例, 结合相关文献,对其MRI资料进行分析,探讨MRI对结核性脑膜炎的诊断价值.     

隐球菌性脑膜炎的CT分析

２０例隐球菌性脑膜炎的ＣＴ扫描进行了回顾性温习，４例ＣＴ扫描正常，其余病例均有阳性ＣＴ扫描发现，包括脑积水、脑内低密度灶、假性囊肿、隐球菌瘤、颅内钙化、弥漫性脑水肿和弥漫性脑膜强化，对ＣＴ表现与病理类型的相关性进行了讨论。     

实时定量PCR检测隐球菌性脑膜炎中TRAIL表达

目的研究建立实时荧光定量(RFQ)-PCR法测定TRAIL mRNA含量的方法,探讨其在隐球菌性脑膜炎患者外周血单个核细胞中表达的检测价值,并分析隐球菌性脑膜炎患者免疫指标与TRAIL的相关性。方法设计特异性的引物和探针,以人基因GAPDH为内参照,用实时定量PCR的方法检测35例健康人和35例隐球菌性脑膜炎患者外周血单个核细胞中TRAIL mRNA的表达水平,采用特定蛋白分析仪测定IgG、IgA、IgM、C3、C4。结果与健康人比较,隐球菌性脑膜炎患者外周血单个核细胞中TRAIL mRNA的表达明显下降(P<0.01)。隐脑患者血清中的C3和IgG显著下降(P<0.01),且与TRAIL的变化成正相关。结论隐球菌性脑膜炎患者TRAIL下降,提示TRAIL可能参与隐球菌性脑膜炎的疾病进程,这为有效治疗隐球菌性脑膜炎提供了新的线索。     

颅内结核性脑膜炎的MRI诊断

目的 评估ＭＲＩ对颅内结核性脑膜炎的诊断价值。材料与方法 对１８例颅内结核怀脑膜炎的ＭＲＩ表现、Ｇｄ－ＤＴＰＡ增强的作用和追踪ＭＲＩ的变化进行分析。结果 ＭＲＩ显示脑膜炎１３例,表现为蛛网膜腔狭窄和消失,脑脊液分房。在增强ＭＲＩ上,受累的脑膜呈线形、弥漫性斑块和结节状或环状显著性强化。结核性脑膜炎合并结核瘤２例,结核性脑脓肿２例,脑梗塞１例。结论 结核性脑膜炎的ＭＲＩ表现有一定的特点,增强ＭＲＩ可     

Carcinomatous Meningitis Appearing as Acoustic Neuromas

BACKGROUND: For acoustic neuromas, stereotactic radiotherapy (radiosurgery or stereotactic fractionated radiotherapy) has been established as an important alternative to microsurgery. In most cases initial symptoms are slow progression of unilateral hearing loss, tinnitus or vertigo or acute hearing loss with vertigo. MRI scan shows a contrast-enhancing tumor within the inner auditory channel. If the patient undergoes primary radiotherapy, diagnosis is usually not verified histologically. Therefore, careful evaluation of the medical history is mandatory despite a typical appearance on the MRI scan. If medical history does not match with acoustic neuroma, further diagnostics are necessary to rule out infectious disease or carcinomatous meningitis. CASE REPORT: Two patients with hearing loss, vertigo and the diagnosis of acoustic neuromas by MRI scan were referred for radiotherapy. In both cases the symptoms progressed very rapidly, not typical of acoustic neuromas, and in both patients repeated liquor puncture finally revealed carcinomatous meningitis. One patient died during therapy; in the second patient intrathecal chemotherapy and additional radiotherapy of the skull base led to partial remission continuing for several months. CONCLUSION: Before primary radiotherapy of small intrameatal lesions diagnosis must be reassessed carefully. This is especially true for bilateral lesions suspicious for acoustic neuromas and rapid progression and persistence of clinical symptoms where carcinomatous meningitis has to be taken into account.     

经颅多普勒在结核性脑膜炎的应用研究

目的　探讨结核性脑膜炎的脑血流动力学的变化特点 ,以及TCD检测在判断病情严重程度和临床预后的应用价值。方法　结核性脑膜炎组 2 0例和对照组正常人 30例 ,对病情及预后进行比较。结果　ACA ,MCA ,VA ,BA血流速度均增快 ;所测动脉PI值均升高。相关分析结果ACA Vs, Vd , Vm和MCA Vs与GCS ,GOS均成负相关 ;MCA PI值与GOS成负相关。结论　结核性脑膜炎异常改变波及颈内动脉系统和椎 基底动脉系统。大脑前、中动脉Vs流速越快 ,提示病情越严重 ,预后越差 ;大脑中动脉PI值越高 ,提示预后越差。     

新生隐球菌脑膜炎临床误诊分析

目的　探讨新生隐球菌脑膜炎误诊的原因及其对策。方法　对本院 1980— 2 0 0 4年确诊的 19例新生隐球菌脑膜炎病人的诊断情况进行回顾分析。结果　 19例确诊前有 17例被误诊 ,其中误诊为结核性脑膜炎 7例 ,脑肿瘤 2例 ,病毒性脑膜炎 3例 ,脑水肿 1例 ,脑蛛网膜炎 1例 ,红斑狼疮脑病 1例 ,其他 2例。结论　提高对新生隐球菌脑膜炎的认识 ,对可疑病人多次做脑脊液墨汁涂片检查 ,或其他检查 ,可减少误诊。     

结核性脑膜炎73例临床分析

目的探讨结核性脑膜炎的临床特点,以提高对结核性脑膜炎的诊断水平。方法对73例结核性脑膜炎的临床资料,包括分型、分期、脑脊液、CT、MRI及治疗进行回顾性分析。结果73例结核性脑膜炎中以脑膜脑炎型最多,其次为脑炎型;多数在脑膜刺激征期;脑脊液不典型者占20.5%(15/73);CT或MRI检查多数(20/36)显示有脑积水。结论综合分析临床表现、脑脊液、CT或MRI及试验性治疗是提高诊断正确率的有效方法。     

化脓性脑膜炎的CT评价

100例化脓性脑膜炎着重于各种并发症的CT 特征进行了回顾性分析,探讨了CT 扫描在颅内化脓性感染的表现及其诊断价值。     

结核性脊膜脊髓炎的MRI诊断

目的 探讨结核性脊膜脊髓炎MRI表现,提高其诊断准确性. 资料与方法 回顾性分析经手术后病理证实或诊断性用药后疗效显著的10例结核性脊膜脊髓炎的MRI表现特点. 结果 10例MRI平扫,7例脊髓内呈结节状、串珠状、条带状异常信号;3例蛛网膜下腔充填稀薄的异常信号;3例脊膜增厚;2例硬膜外见条状异常等信号;3例合并椎体及附件结核伴椎旁冷脓肿;1例合并脑干内多发小结节影;5例MRI增强扫描,4例脊膜增厚强化,2例脊髓内斑点状中度强化,1例脊髓内环状强化. 结论 MRI对结核性脊膜脊髓炎的临床诊断具有重要价值.     

结核性脑膜炎48例误诊分析

目的总结结核性脑膜炎误诊的原因及其教训。方法对48例误诊的结核性脑膜炎回顾分析其一般情况、临床表现、脑脊液检查及影像学资料。结果误诊为血管性头痛22例,神经性头痛14例,偏头痛8例。椎—基底动脉供血不足4例。误诊时间(36±8)d。结论肺部结核证据较少,症状不典型,病情进展缓慢是误诊的主要原因;询问病史不详细、分析病情不全面是误诊的重要教训。     

结核性脑膜炎的CT和MRI诊断及对比分析

目的 :对比研究 CT、MRI扫描对结核性脑膜炎 (简称结脑 )的诊断价值。方法 :5 0例经临床确诊的结脑患者 ,CT平扫和增强扫描 5 0例 ,MRI扫描 31例 ,其中 2 0例作了增强扫描。结果 :CT和 MRI平扫的敏感度分别为 72 %和 77.3% ;增强扫描的敏感度分别为 88%和 90 % ,平扫加增强扫描 CT、MRI的敏感度分别为 90 %和 90 .3%。影像表现为 :脑池及脑膜异常 ,脑积水 ,结核瘤 ,脑梗塞 ,脑炎 ,脑膜钙化 ,血管神经异常。结论 :CT和 MRI扫描对显示结脑较为特征性的脑膜病变和结脑的继发病变都有很高的敏感度。 CT和 MRI增强扫描的敏感度高于各自平扫。 MRI显示病变波及范围和继发病变优于 CT。     

Eitrige Meningitis,akut entstanden nach Kopftrauma ohne nachweisbare Wunde

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