中枢神经系统结核误诊分析(附35例临床病理报告)

目的探讨中枢神经系统结核诊断及误诊原因.方法分析了35例生前被误诊、尸解病理证实的中枢神经系统结核.结果误诊为化脓性脑膜炎9例,病毒性脑炎7例,乙型脑炎4例,脑肿瘤及脑积水各3例,视神经脊髓炎、脑脓肿、败血症各2例,麻疹、多发性脑脊髓瘤、淋巴瘤各1例.临床表现除脑膜刺激征、颅高压外,可有中枢神经系统局灶损害症状.脑脊液改变为压力升高,细胞计数与蛋白含量增高,糖与氯化物降低.尸检发现脑膜病变为主,脑实质、脑室、脑血管、脊髓均有结核病变.结论中枢神经系统结核临床表现与结核病变性质、部位密切相关,认识其病理类型、临床症状多样性以及动态脑脊液观察有助于提高诊断率.

An analysis of the misdiagnosis of the central nervous system tuberculosis.

Objective To investigate the diagnosis and the misdiagnosis of the central nervous system(CNS) tuberculosis. Methods 35 cases of the CMS tuberculosis confirmed by autospy, which were misdiagnosed before death, were renewed. Results 9 of the 35 cases were misdiagnosed as purulent meningitis, 7 cases as virus meningitis, 4 cases as encephalitis B, 3 each as tu-mor and hydrocephalus respectively, 2 each as opthalmoneuromyelitis, encephalopyosis and sepsis respectively, 1 each as measles. multiple medulloblastoma and lymphoma respectively. Besides manifestations of meningitis and intracranial hypertension, other clinical manifestations included focal neurological signs. The cerebral spinal fluid changes included elevated opening pressure, in-creased cell counts and protein levels, decreased glucose and chlorides levels. Tuberculosis lesions in the meanings, brain parenchyma, ventricles and brain vessels were found at autopsy. Conclusions The clinical manifestations of CNS tuberculosis were related to the location and the pathological changes of tuberculosis. To avoid its misdiagnosis, it is useful to bear in mind the pathologic classitications, the diverse clinical manifestations and the characteristic changes of cerebral spinal fluid examinations.