结核性脑膜炎34例误诊分析

目的 探讨结核性脑膜炎的诊断及误诊原因，以降低其误诊率。方法分析34例经病理证买的结核性脑膜脑炎患的临床资料、脑脊液的改变及影像学表现。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，脑脓肿2例，视神经脊髓炎、败血症各2例，麻疹、多发性脑脊髓瘤各1例。临床表现除脑膜刺激征、颅内高压外，可有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。结论认识结核性脑膜脑炎临床症状的多样性以及动态观察脑脊液变化有助于提高诊断率。

A Misdiagnosis Analysis of Tuberculous Meningitis and Encephalitis

Objective To investigate the diagnosis and the misdiagnosis of the tuberculous meningitis and encephalitis,to reduce the ratio of misdiagnosis. Methods 34 cases of the tuberculous meningitis and encephalitis were comfirmed by pathology.The clinical manifestations and cerebral spinal fluid changes were reviewed. Results 9 cases were misdiagnosed as purulent meningitis, 7 cases virus meningitis, 4 cases encephalitis B, 3 cases tumor and hydrocephalus respectively, 2 cases encephalopyosis, 2 cases opthalmoneuromyelitis and sepsis respectively, 1 cases measles and multiple medullobastoma respectively. Besides manifestations of meningitis and intracranial hypertension, other clinical manifestations included focal neurological signs. The cerebral spinal fluid changes included elevated opening pressure, increased cell counts and protein levels, decreased glucose and chlorides levels. Condusion To avoid its misdiagnosis, it is useful to bear in mind the diverse clinical manifestations and the characteristic changes of cerebral spinal fluid examinations.