结核性脑膜脑炎并结核性脊髓炎的2例临床分析

Clinical Analysis of Two Cases of Tuberculous Meningocephalitis Combined with Tuberculous Myelitis

目的:总结结核性脑膜脑炎并结核性脊髓炎的临床特点、治疗方法及预后。方法:对2例结核性脑膜脑炎并结核性脊髓炎患者的临床资料、实验室检查、影像学资料、组织病理学、治疗方法及预后进行分析。结果:2例患者均有头痛、颅神经麻痹、脑膜刺激征、双下肢乏力、感觉障碍;脑脊液中蛋白明显升高;MRI检查显示有脑膜强化、颅内强化灶及相应节段脊髓肿胀;全身抗痨联合鞘内注射异烟肼和地塞米松治疗有效。结论:结核性脑膜脑炎患者如出现脊髓受损表现或脑脊液蛋白明显增高,而腰穿压力正常或降低等应考虑合并结核性脊髓炎的可能性。早期全身抗痨联合鞘内给药疗效确切。

Objective： To summarize the clinical characteristics, therapy and prognosis of tuberculous meningocephalitis combined with tuberculous myelitis. Methods： Clinical data, laboratory examination, MRI imaging, pathologic histology, treatment and prognosis were analyzed of two cases of tuberculous meningocephalitis combined with tuberculous myelitis. Results： Both patients had headache, cranial nerve palsy, meningeal irritation sign, weakness of lower extremities and hypoesthesia; Cerebrospinal fluid （CSF） analysis revealed a high protein ; Magnetic resonance imaging （MRI） revealed enhancement of thickening meninges and abnormal signal focus in intracranial tissue. However there was diffuse cord swelling without enhancement; Combination treament with traditional antituberculosis drugs and intrathecal injection of isoniazid and dexamethasone had a beneficial effect. Conclusions： Tuberculous myelitis should be suspected whenever a patient with tuberculous meningocephalitis develops spinal cord symptoms or reveals a normal even low pressure but high protein level in CSF. Early diagnosis and traditional antituberculosis therapy combined with intrathecal injection are simple and effective mehods.