新型隐球菌性脑膜炎与结核性脑膜炎的临床鉴别

Differential diagnosis between tuberculous and cryptococcal neoformans meningitis

目的 探讨两种病原体引起的中枢神经系统感染的临床特征 ,评估神经影像学在鉴别诊断中的作用。方法 回顾性对比分析两种脑膜炎的主要临床表现、脑脊液变化、头颅CT或MRI改变。结果 新型隐球菌性脑膜炎起病迁延 ,首发症状至住院诊治有更长间期 ,头痛伴有呕吐 ,视乳头水肿伴有出血 ,脑脊液压力高伴有葡萄糖含量明显减低。结核性脑膜炎急性或亚急性发病 ,腱反射减低或消失 ,脑脊液细胞数增多。两种脑膜炎有着各自神经影像学特征。

Objective To study the clinical and neuroradiological features of central nervous system infections caused by the two different pathogens.Methods The clinical manifestations and CSF changes of 12 cases of crypotococcal neoformans meningitis(CNM) were compared with that of 13 cases of tuberculous meningitis(TBM) retrospectively and analysed statistically.Results The following items were considered significant:in CNM,the patients presented with the longer duration from onset to hospitalization,the higher intracranial hypertension accompanying papilledema and hemorrhage,and the much lower glucose content of CSF.In TBM,the onset was usually acute or subacute,CSF pleocytosis and absent tendon reflexes were the more common manifestations.Each meningitis had its own abnormal neuroimaging changes.Conclusion Clinical symptoms and signs,as well as neuroimaging findings provided possibility and reliability for diagnosing both the diseases.