结核性脑膜炎合并脑结核瘤的临床特点

目的探讨结核性脑摸炎(TBM)合并脑结核瘤的临床特点,以提高对本病的认识和诊治水平。方法对我院2001年1月-2009年12月收治的TBM合并脑结核瘤患者26例的临床资料进行分析,探讨本病的临床特点。结果在TBM合并脑结核瘤时,出现各种脑局灶性损害体征。脑脊液多数呈TBM典型改变。11例在CT及MRI上呈现"靶征",CT发现结核瘤数2～14个,平均6.5±4.2个。MRI发现结核瘤数为2～17个,平均7.4±4.4个。临床治愈出院19例,好转4例,死亡3例。结论 TBM合并脑结核瘤的患者,临床表现复杂,如果出现局灶性脑损害体征,应考虑本病的可能。脑脊液检查不能提示脑结核瘤的存在与否,CT和MRI能显示脑结核瘤的部位、大小及数目等。尽早规范的抗结核综合性治疗,多数病人恢复良好。

The clinical features of tuberculous meningitis combined with brain tuberculoma

Objective To improve understanding,diagnosis and treatment of this situation,we discussed the clinical features of tuberculous meningitis（TBM） combined with cerebral tuberculoma.Methods To analyse 26 patients who suffered from TBM combined with cerebral tuberculoma and meanwhile admitted to the hospital during January 2001 to December 2009,and to investigate the clinical features of this situation.Results The patients of tuberculous meningitis（TBM） combined with cerebral tuberculoma showed the signs of a variety of focal cerebral damage.The majority of cerebrospinal fluid appeared the typical changes of TBM.Imaging studies of 11 cases showed the ＂target sign＂ on CT and MRI,tuberculoma found on CT number 2-14（6.5＋ 4.2） and MRI number 2-17（7.4＋4.4）.There were 19 cases cured,4 cases improved,and 3 died.Conclusion The clinical manifestations of TBM with cerebral tuberculoma were complex.Signs of focal brain damage may indicate this condition.CSF examination could not indicate the presence or absence of the cerebral tuberculoma.However,CT and MRI clearly present the location,size,and number of brain tuberculoma.If we put standardized anti-TB treatment into practice quickly,most patients will recover well.