270例中枢神经系统结核病患者的临床及病理

Clinical and pathological analysis of 270 patients with central nervous systemic tuberculosis

目的 分析中枢神经系统结核病的临床表现、病理特征及其误诊的原因。方法 对 2 70例中枢神经系统结核病患者进行回顾性调查 ,并对其中 32例经尸解病理证实的患者进行分析。结果 临床表现除脑膜刺激征、颅高压外尚有中枢神经系统局灶损害症征。死亡 6 1例 (占 2 2 .5 9% ) ,颅高压是其主要的死因。尸检发现以脑膜病变为主 ,大脑实质、小脑、脑干、脑室及脑血管和脊髓均有病变。误诊 49例 ,其中生前误诊 32例 ,总误诊率为 18.15 %。结论 中枢神经系统结核病的临床表现和预后与结核的病变性质和部位密切相关 ,认识其临床病理分型有助于提高诊断率。

Objective To analyse the clinical manifestation,pathological characteristic and the cause of misdiagnosis on the central nervous systemic tuberculosis.Methods 270 patients with central nervous systemic tuberculosis were analysed by retrospective investigation,32 patients of them proved by autopsy were analysed.Results Clinical manifestation had focal symptoms and signs of central nervous system,besides meningeal irritation sign and intracranial hypertension,61 patients died (the mortality for 22.59%), the principal cause of death was intracranial hypertension.The main lesion was found in the meninges,otherwise brain parenchyma,cerebellum,brainstem,ventricles of the brain,blood vessel of brain and spinal cord also were impaired.49 cases were misdiagnosed and among them 32 cases were misdiagnosed before death,the total misdisgnosis rate was 18.15%.Conclusion Clinical manifestations of central nervous systemic tuberculosis and prognosis related to the location and the pathological changes of tuberculosis.The clinical pathologic classifications of tuberculosis in central nervous system might be helpful for the diagnosis.