摘要
目的探讨小儿结核性脑膜炎的临床特点及磁共振成像（MRI）特征性表现。方法对2012—2014年收治的28例小儿结核性脑膜炎的临床特点及MRI表现进行回顾性分析。结果发病年龄3个月至16岁,其中〈1岁6例,~3岁4例,~7岁2例,~16岁16例;临床表现：发热25例、头痛16例、呕吐10例、抽搐6例、咳嗽5例、腹痛2例、意识障碍1例、乏力1例、颈部包块1例;结核菌素纯蛋白衍生物（PPD）试验6例：阳性3例,阴性3例;潘氏试验13例：阳性12例,阴性1例;在脑脊液、痰液或胃液中找到结核分支杆菌者4例;同时伴有身体其他部位结核26例（26/28）：其中全身多发结核4例,粟粒肺结核5例,其他肺结核17例;MRI表现：基底池改变20例（20/28;）颅内结核瘤21例（21/28）;脑萎缩7例（7/28）;脑梗死4例（4/28）;脑积水22例（22/28）：其中轻度12例、中度5例、重度5例;经抗结核治疗有效者21例,病情危重放弃治疗6例（重度脑积水3例,脑梗死3例）,未治疗出院1例。结论小儿结核性脑膜炎临床表现多样,实验室检查阳性率较低,MRI检查能够了解病灶的部位、分布、特性,脑积水的程度,脑梗死及脑萎缩的发生等,对临床治疗方案的选择及预后的评估有指导意义。
Objective To investigate the clinical features and magnetic resonance imaging （MRI）characteristics of tuberculous meningitis in children. Methods The clinical features and MRI findings of 28 children with tubercu- lous meningitis, who were hospitalized between 2012 and 2014, were retrospectively analyzed. Results The age of patients ranged from 3 months to 16 years old, including 6 case less than 1 years old, 4 of 3 years old, 2 of 7 years old, and 16 of 16 years old. Clinical features： 25 eases of fever, 16 of headache, 10 of vomiting, 6 of convulsions, 5 of cough, 2 of abdominal pain, 1 of unconsciousness, 1 of fatigue, and 1 of neck mass. Six eases underwent PPD test： positive in 3 eases and negative in 3 cases. Thirteen eases underwent Pan＇s test： positive in 12 cases and negative in 1 ease. The Myeobaeterium tuberculosis was found in the cerebrospinal fluid, sputum or gastric juice in 4 eases. Tu- berculous meningitis accompanied with tuberculosis other parts of the body was found in 26 cases （26/28）, including 4 of systemic multiple tuberculosis, 5 of miliary pulmonary tuberculosis, and 17 of other pulmonary tuberculosis. MRI findings： 20 eases of basilar cistern changes （20128）; 21 of intracranial tubereuloma （21128）; 7 of cerebral atrophy （7/ 28）; 4 of cerebral infarction （4/28）; 22 of hydrocephalus （22/28）, including 12 of mild, 5 of moderate and 5 of severe. Effective anti-tuberculosis treatment was found in 21 eases. Six cases in critical condition gave up treatment （3 of severe hydrocephalus and 3 of cerebral infarction）. One case was not treated and discharged. Conclusion Tuberculous meningitis in children shows complicated clinical features and low positive rate of laboratory examination. MRI examination may identify the location, distribution, characteristics of the lesion, degree of hydrocephalus, and the occurrence of cerebral infarction and brain atrophy, which is useful in the protocols of clinical treatment, and evaluation of prognosis.
出处
《中国药物与临床》
CAS
2016年第8期1118-1120,共3页
Chinese Remedies & Clinics
关键词
儿童
结核
脑膜
磁共振成像
症状和体征
Child
Tuberculosis meningeal
Magnetic resonance imaging
Symptoms and signs
