误诊结核性脑膜炎38例临床分析

The analysis of 38 patients who were misdiagnosed to be tuberculosis meningitis

目的 提高对结核性脑膜炎鉴别诊断水平。方法 1985年 1月至 2 0 0 0年 10月住院结核性脑膜炎 342例中对非结核性脑膜炎患者误诊为结核性脑膜炎的 38例进行回顾分析。结果 总误诊率 11.1% (38 342 )。误诊疾病病毒性脑膜炎 19例占误诊病例 5 0 .0 % ,新型隐球菌脑膜炎 7例占18.4 % ,脑囊虫病 3例占 8.0 % ,红斑狼疮脑病、急性播散性脑脊髓炎各 2例 ,各占 5 .3% ,脑脓肿、松果体旁囊肿、脑室膜瘤、脑胶质瘤、非特异性大脑导水管狭窄各 1例 ,均占 2 .6 %。误诊时间最短 2d ,最长 36 0d ,平均 37d。结论 ①结核病专科医师应熟悉其他脑部疾病临床表现 ,提高结核性脑膜炎的诊断与鉴别水平。②对临床经过和脑脊液 (CSF)表现不典型、抗结核治疗效果不良的结核性脑膜炎患者 ,应提高警惕 ,需进一步排除隐球菌性脑膜炎及脑囊虫病等其他脑部疾患。③对起病急、进展快、早期出现意识障碍、截瘫、括约肌功能障碍 ,而CSF改变轻微者 ,应考虑急性播散性脑脊髓炎的可能。④脑部CT(增强 )或核磁共振检查对结核性脑膜炎诊断。

Objective To develop the differential diagnosis level for the tuberculosis meningitis (TM).Methods 38 patients were misdiagnosed to be TM in all of 342 patients who were diagnosed to be TM from Jan for 1985 to Oct of 2000.The 38 misdiagnosed TM patients were summarized and retrospectively analyzed.Results The overall missed rate was 11.1%(38/342).The differential diagnoses for the 38 missed patients were respectively virus meningitis 19 (50%),cryptococcus meningitis 7(18.4%),cerebral cysticercosis 3(8.0%),erythema lupus for brain 2(5.3%),acute disseminated encephalomyelitis 2(5.3%),cerebral abscess,cyst beside epiphysis,meningioma,gliocytoma,non-specific narrow of cerebral duct respectively 1(2.6%).The delayed time from 2 days to 360 days,the average was 37 days.Conclusion (1)Tuberculosis physician should know the clinical manifestation of other brain diseases,so that can develop the level of diagnosis or differential diagnosis for tuberculosis meningitis.(2)We should pay attention to these patients whose clinical manifestations and CSF tests are atypical,and the patients who are not effect to the anti-tuberculosis chemotherapy.For these patients,we should further differentiate it from cryptococcus meningitis and cerebral cysticercosis or other brain diseases.(3)The acute disseminated encephalomyelitis should be considered if the patient's disease occurred urgently and progressed rapidly,or in the early stage occrurred consciousness obstruction,paraplegia and sphincter's function failure,but the CSF changed slightly.(4)CT (especially concentration) or MRI tests for brain can play a very important role of diagnosis and differentiation for TM.