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隐球菌脑膜炎是一种深部霉菌感染性疾病,临床表现复杂,易于发生误诊,以致得不到及时正确的治疗。我院自1975年至今收治的14例中,在外院或本院发生误诊9例。本文报告误诊情况,着重分析延误诊断的原因,以冀从中吸取经验教训,提高诊断水平。误诊病例 1.误诊为结核性脑膜炎(简称“结脑”)5例: 例1:男,45岁,农民。1975年3月27日入院。患者于一个多月前出现头痛,前额部为重,逐日加剧。一周前突起恶心,呕吐,右侧肢体麻木。检查:体温37.6℃,脉搏60,血压130/75。意识清,眼底右侧视乳头水肿,左侧正常,双眼外展受限。颈硬,Kernig氏征(+)。血白细胞正常,脑超声波及同位素脑扫描无异常。腰穿脑脊液滴出速度快,无色透明,Pandy(+),自细胞144,多核30％,单核70％,糖1～5管(+),氯化物584毫克％。
Cryptococcal meningitis is a deep fungal infection of the disease, the clinical manifestations of complex, prone to misdiagnosis, resulting in less than timely and correct treatment. Among the 14 cases admitted to our hospital since 1975, 9 cases were misdiagnosed in the hospital or in our hospital. This article reports misdiagnosis, focusing on the analysis of the reasons for the delay in diagnosis, in order to learn from the experience and lessons to improve the diagnostic level. Misdiagnosed cases 1. Misdiagnosed as tuberculous meningitis (referred to as “knot brain”) 5 cases: Example 1: Male, 45 years old, farmer. March 27, 1975 admitted to hospital. Patients had a headache more than a month ago, with a heavy forehead and a daily increase. A week ago nausea, vomiting, numbness of the right limb. Check: body temperature 37.6 ℃, pulse 60, blood pressure 130/75. Consciousness, the right side of the fundus papilledema, left normal, limited eyes outreach. Hard neck, Kernig’s sign (+). Normal blood leukocytes, brain ultrasound and isotope brain scan no abnormalities. Lumbar puncture cerebrospinal fluid drip speed, colorless and transparent, Pandy (+), since the cell 144, multi-core 30%, mononuclear 70%, sugar 1 ~ 5 tube (+), chloride 584 mg%.