常见中枢神经系统感染临床、CSF特征及鉴别诊断

Clinical features and abnormal cerebrospinal fluid findings in patients with central nervous system infectious

目的分析常见中枢神经系统感染性疾病在临床表现及脑脊髓液（CSF）特征的异同点。方法回顾性总结296例中枢神经系统感染性疾病的临床表现及CSF表现。结果高热以病毒脑和化脑常见（62％和67％），以头痛为首发症状者隐脑多见（60％）；抽搐多见于病毒脑（63％）；隐脑出现视力改变（40％）、听力下降（45％）、视神经乳头水肿（74％）及脑疝（41％）的比例明显高于其他组；54％的病毒脑出现肢体瘫痪；化脑外周血白细胞显著升高且以多核细胞为主（64％超过20×10^9／L）。CSF检查结果：隐脑的CSF压力升高最明显（91％大于3．96kPa）；化脑白细胞升高明显（76％大于400×10^6／L）；化脑（74％）和结脑（82％）氯化钠浓度下降；结脑蛋白质升高最显著（48％大于2g／L）。结论隐脑、结脑在临床及CSF变化上相似，CSF压力及蛋白质含量是鉴别的重要指标。化脑、病毒脑的临床诊断相对容易。

Objective To search for the main differential points in chnical features and CSF findings in patients with central nervous system infectious diseases caused by different pathogens. Methods 296 cases with infectious diseases in central nervous system were studied retrospectively. Clinical features and CSF findings before administration of specific antibiotics were compared. Results Viral meningitis or encephalitis （VM） and purulent meningitis （PM） patients usual had high fever（62% and 67% ）. 60% cryptococcal meningitis （CCM） patients had headache without fever at the onset. The incidences of convulsion in VM were higher than those in the others （ 63% ）. The incidences of failing eyesight （ 40% ）, heating defeat （ 45% ） , optic papilla edema （74%） and brain hernia （42%） in CCM patients are higher than the other groups. Paralysis is more common in VM patients （55%） than that in the others. The leukocytosis of peripheral blood in PM patients is remarkable （64% over 20 ×10^9/L） ,with polymorphonuclear leukocytes predominating. CSF examinations：the patients CCM have much higher initial CSF pressure （91% over 3.96 kPa）. Elevation of leukocytes in PM patients is most significant （76%over 400 ×10^6/L）. The concentration of sodium chloride in the PM （74%） and tuberculous meningitis （TBM 82% ） patients often reduced. Extreme elevation of the protein （2 g/L or more） was usually observed in TBM patients （48%）. Conclusion The patients with CCM and TBM were similar in manifestations and the findings of CSF. The CSF pressure and the level of protein in CSF were the important markers for their differential diagnosis. It is more easy to make a diagnosis in PM or VM patients.