结核性与隐球菌性脑膜炎的鉴别诊断

目的　探讨结核性脑膜炎（结脑）和隐球菌性脑膜炎（隐脑） 的临床和脑脊液鉴别要点。方法　回顾性调查并比较１９８３ 年２ 月～１９９７ 年１２ 月收治的５３ 例结脑和５５ 例隐脑患者的临床表现和特效治疗前的脑脊液（ＣＳＦ） 结果。结果　９％ 的结脑和４９％ 的隐脑以头痛为首发症状，结脑和隐脑发生视力改变、听力下降、肢体瘫痪的比例分别为３％ 和３６ ％ ，２％ 和１６ ％ ，１９％ 和０ ；视神经乳头水肿的发生率分别为１５％ 和６６％ ，且隐脑患者多为中、重度水肿。发生脑疝的比例分别为１１ ％ 和２９％ 。９０％ 的隐脑和１１％ 的结脑患者ＣＳＦ压力＞４００ ｍｍ Ｈ２Ｏ。３６％ 的隐脑患者ＣＳＦ中蛋白质含量正常，有升高者大部分为轻度升高，＞２ ｇ／Ｌ者仅占９％ ，而结脑均有蛋白质含量升高，且４５％ 的患者＞２ ｇ／Ｌ。结论　患者具有下列特征时考虑隐脑可能性大：起病时以头痛为主而不伴发热，听力损害出现早，中、重度视神经乳头水肿，ＣＳＦ压力显著升高，蛋白含量正常等。而感染中毒症状突出，ＣＳＦ中蛋白含量明显升高，特别是＞２ ｇ／Ｌ时，结脑的可能性较大。

Differential diagnosis in patients with tuberculous meningitis and cryptococcal meningitis

Objective To search for the main differential points in clinical and CSF changes between patients with tuberculous meningitis (TBM) and cryptococcal meningitis (CCM) Methods Fifty three cases of TBM and 55 cases of CCM who admitted to hospital from Feburary 1983 to December 1997 were investigated retrospectively Main symptoms, signs and CSF changes before administration of specific antibiotics were compared Results 9%(5/53) TBM and 49% (27/55 ) CCM patients had headache without fever at the onset The incidences of symptoms of failing eyesight, hearing loss and paralysis of extremities were 13% (7/53) and 36%(20/55), 2%(1/53) and 16% (9/55), and 19% (10/53) and 0 in TBM and CCM patients respectively The rate and the degrees of optic papilla edema in CCM patients (66%, 16/36 slight, 13/36 moderate, and 7/36 serious) were significantly higher and more serious than that in TBM (15%, 8/8 slight) The patients with initial CSF pressure over 400 mm H 2O were 11% and 90% in TBM and CCM All but 20 CCM patients had elevation of CSF protein content, and 45% (24/53) TBM and 9%(5/55) CCM were >2 g/L Conclusions This study shows that the most important differences between TBM and CCM are: headache not accompanied by fever at the onset, failing eyesight, striking elevation of initial CSF pressure, moderately and serious degree of optic papilla edema, normal CSF protein content occurs usually in CCM more than those in TBM patients On the other hand, striking elevation of CSF protein content (>2 g/L) occurs usually in TBM patients