Tuberculosis of the central nervous system
Tuberculosis of the central nervous system
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DOI：
10.1136/pgmj.75.881.133
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发表时间：
1999-03-01
影响因子：
5.1
通讯作者：
Garg, RK
中科院分区：
文献类型：
--
作者：
Garg, RK
结核性脑和脊髓受累是发展中国家常见的神经系统疾病，最近在发达国家又有死灰复燃的迹象。结核性脑膜炎是一种重要的表现，与高发病率和死亡率有关。诊断基于临床特征、脑脊液变化和影像学特征。由于血清学检查没有足够的敏感性和特异性，细菌学上的确认在所有病例中都是不可能的。聚合酶链反应显示了未来的前景。适当的化疗药物应尽早施用，尽管在化疗方案或最佳治疗时间方面没有一致意见。患者的临床分期是最重要的预后因素。皮质类固醇的作用是有争议的，但它们应该给所有的III期患者。外科手术的目的是治疗脑积水。局灶性病变，颅内结核瘤和结核性脓肿，通常位于大脑或小脑半球，脑干少见，脊髓罕见。他们通常不需要手术干预，对抗结核治疗和皮质类固醇治疗反应良好。
Tuberculous involvement of the brain and spinal cord are common neurological disorders in developing countries and have recently shown a resurgence in developed ones. Tuberculous meningitis is an important manifestation and is associated with high morbidity and mortality. Diagnosis is based on clinical features, cerebrospinal fluid changes, and imaging characteristics. Bacteriological confirmation is not possible in all cases as serological tests do not have sufficient sensitivity and specificity. The polymerase chain reaction shows promise for the future. Appropriate chemotherapeutic agents should be administered as early as possible, although there is no unanimity concerning chemotherapeutic regimens or optimal duration of treatment. The patient's clinical stage at presentation is the most important prognostic factor. The role of corticosteroids is controversial but they should be administered to all patients presenting in stage III. Surgical procedures are directed at management of the hydrocephalus. Focal lesions, intracranial tuberculomas, and tuberculous abscesses, are usually located in cerebral or cerebellar hemispheres, uncommonly in brainstem and very rarely in spinal cord. They do not usually require surgical intervention and respond well to antituberculous treatment, along with corticosteroids.