16例脑内多发结核瘤的临床分析

2017-10-17陈继华

中风与神经疾病杂志 2017年9期

关键词：信号

党静，陈继华

16例脑内多发结核瘤的临床分析

党静，陈继华

目的提高脑内多发结核瘤的诊断和治疗水平。方法回顾分析我院收治的16例脑内多发结核瘤患者的临床表现、腰穿脑脊液结果、影像学表现及治疗效果。结果多数患者以发热、头痛起病，意识障碍2例，癫痫发作1例，眼外肌麻痹7例，偏瘫3例，脑膜刺激征6例，合并血行播散型肺结核1例，腰穿压力升高13例，蛋白升高12例，氯化物降低10例，糖降低8例，脑脊液常规白细胞升高9例，细胞学混合细胞反应4例，淋巴-单核细胞反应3例。头部MRI示颅内多发结节灶，增强可见均匀闭环强化，可见典型“靶征”。16例患者均行四联规范抗结核治疗，治愈15例，死亡1例。结论综合分析患者临床表现、脑脊液结果和影像学表现基本可明确诊断，抗结核治疗有效可进一步确诊。

结核瘤；脑；诊断；治疗

Abstract：ObjectiveTo improve the level of diagnosis and treatment of multiple intracerebral tuberculomas.MethodsSixteen cases admintted in our hospital and subsequently proved multiple intracerebral tuberculomas were retrospectively analyzed，including their clinical characteristics，cerebrospinal fluid and radiography results，and treatment effect.ResultsThe onset of the disease mostly consisted of fever and headache. Clinical presentations included disturbance of consciousness(2/16)，convulsion(1/16)，ophthalmoplegia(7/16)，hemiparesis(3/16)and mild meningeal signs(6/16). One of those cases followed by blood type disseminated pulmonary tuberculosis. CSF revealed the increased intracranial pressure(13/16)，elvated protein(12/16)，decreased chlorine(10/16) and glucose(8/16)，elevated WBC count(9/16)，combined cell reaction(4/16) and lymphocyte-monocyte reaction(3/16). Cranial MRI showed multiple nodules，enhanced after contrast injection. Some cases showed typical target sign on T2WI. After standard treatment with antituberculosis drugs，15 cases were recovered and one died.ConclusionAnalyzing the clinical feature，results of CSF and cranial MRI can diagnose multiple intracerebral tuberculomas，and the effective treatment of antituberculosis drugs can support the diagnosis more.

Keywords： Tuberculoma； Intracranial； Diagnosis； Treatment

脑内多发结核瘤是一种少见的颅内占位性病变，临床表现不典型，获得有确诊意义的病理学和病原学证据比较困难[1]，误诊率高。本研究回顾了2006年1月～2015年6月我院诊治的16例脑内多发结核瘤，现报道如下。