摘要
目的探讨脑多发结核瘤的临床、脑脊液及病理特点在诊断中的价值及其治疗。方法回顾性分析我院神经内科2002年1月至2008年12月诊治脑多发结核瘤患者13例的临床资料。患者均行3次以上常规腰穿脑脊液检查、头颅CT及MRI检查。采取临床诊断(7例)和脑活检病理诊断(6例)。均予以抗结核治疗,其中6例行手术治疗。13例随访时间10个月至4.5年。结果患者症状多以发热、头痛急性起病,意识障碍4例,瘫痪4例,抽搐3例,脑膜刺激征8例,眼肌麻痹3例。脑脊液检查:压力升高10例,蛋白增高12例,糖减低9例,氯化物减低7例。脑脊液白细胞升高7例、正常6例,细胞学2例见混合性细胞反应,3例呈淋巴-单核细胞反应。头颅MRI均显示颅内多发结节或占位病变,增强提示强化,部分病例呈典型"环靶征"。6例开颅脑活检确诊为结核性肉芽肿。抗酸染色2例呈阳性。13例经过正规的抗结核治疗及手术治疗后,痊愈11例,死亡2例。结论脑脊液及MRI检查特点在脑多发结核瘤的诊断中具有重要地位,确诊依靠脑组织病理检查。一旦确诊应正规抗结核治疗,必要时行手术治疗。
Objective To explore the clinical features of multiple intracerebral tuberculoma and its treatment.MethodsThirteen cases admitted in our department from January 2002 to December 2008 were retrospectively analyzed,and their medical data,radiography,cerebrospinal fluid study and pathological feature were evaluated.Meanwhile,their diagnosis and treatment were discussed in combination with literatures.ResultsThe clinical presentations mostly consisted of fever,headache,and focal neurological deficits such as drowsiness（4/13）,hemiparesis（4/13）,convulsion（3/13）,ophthalmoplegia（3/13）and mild meningeal signs（8/13）.Cerebrospinal fluid assay results showed that the pressure of CSF elevated（10/13）,protein elevated（12/13）,glucose decreased（9/13）,chlorine（Cl）decreased（7/13）and normal（6/11）WBC count or moderately elevated（7 /11）.CSF cytology showed that 2 cases had combined cells reaction and 3 cases had lymphocyte-monocyte reaction.MRI revealed that multiple nodules or diffuse solitary lesions（13/13）.Immature tuberculoma showed hypointense signal on T1WI and hyperintense signal on T2WI and nodular enhancement after contrast injection,and were surround by obvious edema tissue.Some cases showed typical target sign on T2WI.Histopathological examination revealed tuberculosis granulomatous inflammation in 6 cases and 2 cases of positive anti-acid staining.After standard treatment with antituberculosis drug and surgery operation,11 cases were recovered and 2 cases died.ConclusionThe characteristics of cerebrospinal fluid assay and MRI images play important role in the diagnosis of brain multiple tuberculoma,and positive diagnosis should be identified through brain histopathologic examination.The antituberculosis drug treatment is efficient but it must be standard and in a long term.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2010年第7期715-718,共4页
Journal of Third Military Medical University
基金
第三军医大学大坪医院野战外科研究所"1135"优秀人才工程专项基金(2006112)~~
关键词
结核瘤
颅内
脑脊髓液
体层摄影术
X线计算机
磁共振成像
病理学
临床
uberculoma
intracranial
cerebrospinal fluid
tomography
X-ray computed
magnetic resonance imaging
pathology
clinical
