目的 探讨近几年结核性脑膜炎的临床特点及影响预后相关因素.方法 回顾性分析2002年1月~2007年12月南京脑科医院87例结核性脑膜炎患者临床特点、脑脊液(CSF)变化、影像学改变及其转归.结果 结核性脑膜炎患者临床特点多以头疼、发热及脑膜刺激症为主,缺乏典型结核中毒症状;87例患者头颅CT或MRI资料,其中38例检查有异常发现.87例患者中4例院内死亡,6例转外院.83例患者中,60例随访到,失访率27.7%.随访时间从1到4年,平均2 0.18年,10例遗留不同程度神经系统并发症,8例死亡,42例临床治愈.结论 结核性脑膜炎的转归和预后取决于早期诊断和治疗.其临床症状多无特异性,对临床表现不典型者进行动态观察,反复做腰穿脑脊液检查.头颅CT和MRI检查对结核性脑膜炎诊断非常重要,对高度怀疑结核性脑膜炎的可做诊断性抗结核治疗,避免误诊、误治.%Objective This paper aims at analyzing the clinical features of recent Tubercular Meningitis as well as the factors affecting the prognosis of it. Methods Through the retrospective analysis of the clinical features,the changes of cerebrospinal fluid ( CSF ) and the changes and lapses of iconography of the 87 cases of patients with Tubercular Meningitis in Nanjing Brain Hospital from January 2002 to December 2007. Results This paper has noticed that patients with Tubercular Meningitis were mainly clinically characterized with headache , fever and meningismus, lacking of the typical Tubercular poisoning symptoms; among the 83 patients with head CT examination or MRI examination, 38 were found unusual; among the 87 patients, 4 died in the hospital, 6 were transferred to other hospitals and among the living 83 , 60 accepted the telephone follow-up with 27. 7 percent inaccessible; the follow-up time ranged from 1 year to 4 years, 10 were left with somewhat neurological complications, 8 died and 42 healed.Conclusion From the study and analysis, this paper has summed up that the lapse and prognosis of Tubercular Meningitis are dependent on the early diagnosis and remedy. The clinical symptoms of the disease are mostly without specificity, therefore it is advisable to observe the patients without typical clinical manifestation dynamically and examine their CSF repeatedly. The head CT examination and MRI examination are vital to diagnose Tubercular Meningitis, and to those highly-suspected, the diagnostic treatment against tuberculosis can be applied in order to prevent the misdiagnosis and mistreatment.
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