隐球菌性脑膜炎误诊与结脑34例分析

Differential Diagnosis of Tuberculous Meningitis and Cryptococcus Meningitis

目的 :探讨结脑和隐球菌性脑膜炎 (隐脑 )的临床和脑脊液鉴别要点。方法 :回顾性调查并比较 1 985年～ 2 0 0 0年收治的 34例结脑和 35例隐脑患者的临床表现和有效治疗前的脑脊液 (CSF)结果。结果 :9%的结脑和 49%的隐脑以头痛为首症状 ,结脑和隐脑发生视力改变、肢体瘫痪的比例分别为 1 3%和 36 %、1 9%和 0 ,视神经乳头水肿发生率分别为 1 5%和 6 6 % ,发生脑瘫的比例分别为 1 1 %和 2 9% ,90 %的隐脑和 1 1 %的结脑患者CSF压力大于 40 0mmH2 O ,36%的隐脑患者CSF中蛋白质含量正常 ,有升高者大部分为轻度升高 ,大于 2 g/L者占 9% ,而结脑均有蛋白质含量升高 ,且 45%的患者大于 2 g/L ,结论 :隐脑易误诊 ,具有下列特征时考虑隐脑可能性大。起病以头痛为主而不伴发热 ,视神经乳头水肿明显 ,CSF压力显著升高 ,蛋白含量正常等。CSF中蛋白含量明显升高 ,特别是大于 2 g/L时 ,结脑可能性较大。

ObjectiveTo investigate the main differential points in cl inical menifestations and CSF changes between tuberculous meningitis (TBM) and c ryptococcus meningitis (CCM). Methods Clinical menifestations and CSF findings in 35 patients with T BM and 34 with CCM who were admitted into hospital from 1985 to 2000 were compar ed.Results Headache was found to be the first symptom in 9 % of TBM pat ients and 49 % of CCM.The incidences of failing eyesight,and paralysis of extrem ities were 13 % and 36 %,19 % and 0 in TBM and CCM patients,respectively,The inc idences of papillaedema were 15 % and 66 % respectively,cerebral paralysis was 1 1 % and 29 %,respectively.CSF pressure over 400 mmH 2O was found in 90 % of CCM patients and 11 % of TBM.Normal protein content in CSF was found in 36 % of CCM patients ,the content over 2 g/L in 9 %,whereas the rise in protein content was seen in a ll the TBM patients,and the content over 2 g/L in 45 %.Conclusion CCM is most li kely when patients with the following,like headache with no fever accompanied,s erious papilledema,significantly increased CSF pressure,normal protein content; while TBM is most likely when the protein content in CSF becomes greatly high,es p ecially it is over 2 g/L.