小儿不典型结核性脑膜炎46例临床分析

目的探讨小儿不典型结核性脑膜炎(TBM)的诊断,避免误诊误治。方法对于中枢神经系统感染疑似TBM的病人,详细询问病史及体检,并对脑脊液、头颅CT、胸片、PPD、结核抗体等综合分析。结果46例病人中农村病人35例,城镇病人11例;脑脊液异常43例;头颅CT异常37例;PPD阳性36例;外周血结核抗体阳性24例;脑脊液结核抗体阳性27例;外周血、脑脊液结核抗体同时阳性14例;43例作脑电图,异常36例。结论儿童TBM多不典型,详细询问病史和仔细的体检,对辅助检查的综合分析,保持对儿童TBM的高度警惕性是减少对此病误诊的关键。

Clinical Analysis of 46 Cases with Atypical Tuberculous Meningitis in Children

Objective To investigate early diagnosis of atypical tuberculosis meningitis in children for avoiding misdiagnosis and mistreatment. Methods Forty six patients with central nervous system infection resembling tuberculous meningitis (TBM), obtained detailed enquiry about medical record and physical examination. The laboratory examination including cerebrospinal fluid, cerebral computerized tomography, chest film, PPD test and tubercular antibody (TB-Ab) test were made and comprehensively analyzed.Results Among 46 patients, there were 35 cases from village while others were from town. 43 cases were abnormal cerebrospinal fluid. 37 abnormal cerebral computerized tomography; 36 PPD test positive. The cases of positive TB-Ab in peripheral blood, cerebrospinal fluid and both body fluids were 24,27and 14 respectively. There were 36 abnormal electroencephalograms among 43 cases. Conclusions The TBM in children usually present atypical features. The key points of avoiding misdiagnosis include inquiring history in detail, elaborative medical examination, comprehensive analysis of auxiliary examination findings, and keeping alertness to the disease.