脑多发性结核瘤11例的临床、脑脊液细胞学与病理特点

目的 探讨脑多发性结核瘤的临床、脑脊液细胞学和病理特点。方法 回顾性分析2000年11月至2005年5月我院诊治的脑多发性结核瘤11例。结果 患者临床上以发热和头痛起病，脑膜刺激征4例，意识障碍5例，偏瘫3例，抽搐2例。脑脊液压力升高8例，脑脊液蛋白升高10例，糖减低7例。脑脊液常规白细胞计数正常7例，升高4例；脑脊液细胞学见4例呈混合性细胞反应，2例呈淋巴-单核细胞反应，3例未见异常。11例头MRI均显示脑内多发结节或占位性病变，11例强化明显。5例开颅脑活检证实为结核性肉芽肿，抗酸染色阳性3例。结论 脑内多发性结核瘤是一种特殊类型的颅内结核感染，综合其临床表现、影像学和脑脊液细胞学等特点有助于临床诊断。

Multiple intra-cerebral tuberculomas:clinical,cerebrospinal fluid cytological and pathological studies of 11 cases

Objective To clinically analyze the cerebrospinal fluid cytological and pathological feature of multiple intra-cerebral tuberculomas.Methods Eleven cases were retrospectively analyzed over the past 5 years in PUMC hospital, whose medical record, radiography, cerebrospinal fluid cytological study were evaluated. Brain biopsy was performed in 5 cases. Results The clinical presentations mostly consisted of fever and headache (11/11)and increased intracranial pressure (8/11)with diffuse or focal neurological deficits such as drowsiness (5/11), hemiparesis (3/11), convulsion (2/11) and mild meningeal signs (4/11) . MRI showed multiple nodules (8/11) or diffuse solitary lesions (3/11), enhanced by Gd-DTPA in brain parenchyma, focal meningeal enhancement was present only in 1 case. Studies of CSF revealed moderated protein elevations (10/11) and normal (7/11) or moderately elevated (4/11) WBC count or moderately elevated (4/11). CSF cytology studies showed acute inflammatory reaction suggesting infection in 6 cases despite of normal WBC count. Brain biopsy showed focal lesion in parenchyma without meningeal involvement. Histopathologic examination revealed tuberculosis granulomatous inflammation in 5 cases and 3 cases of positive anti-acid staining. Conclusion Multiple intra-cerebral tuberculomas is a special type of intracranial tuberculosis so far as its clinic feature and pathology concerned.