CAJ | 학술논문

目的：探讨小儿结核性脑膜炎的临床特点及早期诊断方法。方法回顾性分析2009年10月至2012年10月在我院确诊或临床诊断为结核性脑膜炎的68例住院患儿的临床资料。结果68例病例中,男36例,女32例,年龄(4±4.35)岁。5例确诊病例,脑脊液结核杆菌培养阳性；63例为临床诊断病例。临床主要表现为：发热64例(94%)；头痛和/或呕吐38例(56%)；抽搐26例(38%)；意识障碍33例(48%)；脑膜刺激征阳性38例(56%)；偏瘫27例(40%)；25例伴颅神经损害,以动眼神经和外展神经受损为主。合并脑外结核47例(69%)。未接种卡介苗18例(27%),有明确肺结核接触史28例(42%)。脑脊液异常62例(92%),呈非化脓性改变,白细胞增高以淋巴细胞为主,蛋白质升高,糖、氯化物降低。头颅影像学有异常发现62例(92%),脑室扩张、交通性(梗阻性)脑积水和脑梗死最常见。全部病例均接受抗结核治疗,12例行侧脑室外引流术,其中11例转神经外科行脑室-腹腔分流术。好转或治愈62例(92%),后遗症28例(42%),自动出院2例(4%),死亡2例(4%)。结论该病临床表现复杂多样,早期症状和体征均缺乏特异性,仔细询问病史和结核接触史,结合脑脊液、头颅影像学、结核菌素试验是早期诊断的关键。
목적：탐토소인결핵성뇌막염적림상특점급조기진단방법。방법회고성분석2009년10월지2012년10월재아원학진혹림상진단위결핵성뇌막염적68례주원환인적림상자료。결과68례병례중,남36례,녀32례,년령(4±4.35)세。5례학진병례,뇌척액결핵간균배양양성；63례위림상진단병례。림상주요표현위：발열64례(94%)；두통화/혹구토38례(56%)；추휵26례(38%)；의식장애33례(48%)；뇌막자격정양성38례(56%)；편탄27례(40%)；25례반로신경손해,이동안신경화외전신경수손위주。합병뇌외결핵47례(69%)。미접충잡개묘18례(27%),유명학폐결핵접촉사28례(42%)。뇌척액이상62례(92%),정비화농성개변,백세포증고이림파세포위주,단백질승고,당、록화물강저。두로영상학유이상발현62례(92%),뇌실확장、교통성(경조성)뇌적수화뇌경사최상견。전부병례균접수항결핵치료,12례행측뇌실외인류술,기중11례전신경외과행뇌실-복강분류술。호전혹치유62례(92%),후유증28례(42%),자동출원2례(4%),사망2례(4%)。결론해병림상표현복잡다양,조기증상화체정균결핍특이성,자세순문병사화결핵접촉사,결합뇌척액、두로영상학、결핵균소시험시조기진단적관건。
were note extra-CNS TB. 27% children had not received BCG, and 42% cases had exposure to tuberculosis patients. CSF of 62 cases showed abnormalities, which were non-purulent, high classification of lymphocytes, high protein concentrations and low concentrations of glucose as well as chloride. Obvious abnormalities in brain CT or MRI were presented in 62 cases (92%), such as ventriculomegaly, communicating/obstructive hydrocephalus and cerebral in-farction. All isolates had accepted anti-TB treatment. 12 children underwent external ventricular drain, and 11 cases underwent ventriculoperitoneal shunt surgery. 62 cases had good outcome, but 28 children had neurological sequelae. 2 cases of death reported ( 4%) . Conclusion The clinic features of pediatric tubercular meningitis is incomplete and the clinical findings are usually non-distinctive. The diagnosis of pediatric tubercular meningitis depends upon contact history, test of CSF, brain CT/MRI and tuberculin skin test.