肺结核合并大面积脑梗死1例

在所有结核病感染中，大约有10％至15％会侵犯中枢神经系统（Central Nervous System CNS）[1]，导致结核性脑膜炎（Tuberculous meningitis TBM），浆液性脑膜炎，结核瘤，结核性脓肿，脑病或脊髓性脑膜炎等[2]，大面积脑梗死(massive cerebral infarction, MCI)是指大脑中动脉供血区域梗死面积达2/3或以上者，最大病灶直径通常> 8 cm且梗死范围累及2个及以上脑叶。MCI起病较急且进展迅速,可在早期出现神经功能缺损并形成脑疝,导致患者发生意识障碍并持续加重,患者预后多不良,病死率高达78%,且存活患者中约89%可遗留严重的神经功能障碍。现将我院呼吸科1例肺结核合并大面积脑梗死患者报道如下。

Pulmonary tuberculosis complicated with massive cerebral infarction:a case report

Tuberculosis is one of the infectious diseases with high morbidity and mortality. Mycobacterium tuberculosis can invade the central nervous system in a variety of ways, The common clinical manifestations are headache, epilepsy, encephalopathy and cerebral infarction. The diagnosis and treatment are easily delayed in clinical practice. A 62-year-old male patient with pulmonary tuberculosis complicated with massive cerebral infarction was reported. Epilepsy was the first symptom. Bronchoscopic bronchoalveolar lavage fluid test showed positive acid-fast bacilli. Cranial MRI and CT showed massive cerebral infarction. Due to large infarct size, craniotomy was performed for bone flap removal. The patient died of organ failure during follow-up. This case suggests that patients with early suspected Mycobacterium tuberculosis infection and neurological deficit symptoms should be vigilant for serious complications and their differential diagnosis to avoid missed diagnosis or misdiagnosis.