15例中枢神经系统结核合并脑动脉内膜炎患者的临床特征  

Clinical characteristics of 15 cases of central nervous system tuberculosis complicated with cerebral endarteritis

作　　者：韩玮欣 赵立明 程珊珊 孟艺哲 陈颜强[1] HAN Wei-xin;ZHAO Li-ming;CHENG Shan-shan;MENG Yi-zhe;CHEN Yan-qiang(Department of Internal Neurology,Hebei Chest Hospital,Shijiazhuang 050047,China)

机构地区：[1]河北省胸科医院神经内科,石家庄050047

出　　处：《结核与肺部疾病杂志》2022年第3期227-230,共4页Journal of Tuberculosis and Lung Disease

基　　金：河北省卫生厅科研基金(20200820)。

摘　　要：目的:探讨中枢神经系统结核合并脑动脉内膜炎的临床特点,提高对中枢神经系统结核合并脑动脉内膜炎的认识。方法:回顾性分析河北省胸科医院2019年4月至2021年12月收治的15例中枢神经系统结核患者的临床资料,所有患者均行头颅核磁平扫+头颅核磁增强扫描+头颅核磁脑动脉成像检查,对患者的基本资料、病史、临床表现、实验室检查、影像学特征及病原学检查等进行分析。结果:15例中枢神经系统结核患者均同时合并其他部位结核,其中合并肺结核10例、合并骨关节结核2例、结核性胸膜炎2例、腰椎结核1例、淋巴结结核3例、结核性视网膜病变1例;发病初期临床表现以头痛伴发热为最常见(12例),还可出现胡言乱语、意识障碍(3例),甚至可出现肢体活动障碍(1例)等。脑脊液检查显示,12例患者颅内压升高(>200 mm H_(2)O),11例脑脊液蛋白水平明显高于正常,9例脑脊液白细胞计数升高(>100×10^(6)/L),8例葡萄糖含量降低,7例氯化物含量降低。15例患者中,14例头颅核磁脑动脉成像均发现不同程度颅内动脉狭窄,13例合并脑梗死。出院时所有患者病情均较前明显好转,但2例患者出现肢体活动障碍及认知功能障碍等明显后遗症。结论:中枢神经系统结核合并脑动脉内膜炎可导致脑梗死,最常累及穿支和末端皮质分支动脉供应区,同时可导致颅内动脉狭窄,在诊治过程中应早期及时给予血管及神经保护治疗。Objective:To explore the clinical characteristics of central nervous system tuberculosis complicated with cerebral arteritis,and to improve the understanding of it.Methods:The clinical data of 15 cases of central nervous system tuberculosis admitted to Hebei Chest Hospital from April 2019 to December 2021 were analyzed retrospectively.All patients underwent head MRI plain scan+MRI enhanced scan+cerebral magnetic resonance angiography(MRA).The basic data,disease history,clinical manifestations,results of laboratory and etiological examinations,and imaging characteristics of those patients were analyzed.Results:Fifteen patients with central nervous system tuberculosis were all complicated with tuberculosis in other organs,including 10 cases complicated with pulmonary tuberculosis,2 cases with bone joint tuberculosis,2 cases with tuberculous pleurisy,1 case with lumbar tuberculosis,3 cases with lymph node tuberculosis and 1 case with tuberculous retinopathy.The most common clinical manifestations in the early stage of onset were headache with fever(12 cases),allophasis,disorders of consciousness(3 cases),and even physical mobility impairment(1 case).Cerebrospinal fluid examination showed that the intracranial pressure increased in 12 cases(>200 mm H_(2)O),the protein level was significantly higher than normal in 11 cases,the leukocyte count increased in 9 cases(>100×10^(6)/L),the glucose decreased in 8 cases and the chloride decreased in 7 cases.Among the 15 patients,14 cases were found to be having intracranial artery stenosis by cranial MRA,and 13 cases had cerebral infarction.At the time of discharge,conditions of all patients were significantly improved,but 2 patients had obvious sequelae such as physical mobility and cognitive impairment.Conclusion:Central nervous system tuberculosis complicated with endarteritis can lead to cerebral infarction,which often involves the branches of perforating branches and terminal branches of the cerebral cortex,and can also lead to intracranial artery stenosis.Therefore,in th

关 键 词：结核 中枢神经系统 脑动脉 疾病特征 

分 类 号：R529.3[医药卫生—内科学] R741[医药卫生—临床医学]