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我院于1978～1995年收治结核性脑膜炎171例,其中误诊21例(12.3％),因感冒或腹泻后头痛、呕吐误诊为“散发性脑炎”15例;发热、头痛、关节痛、血沉增快误诊为“风湿热”4例;发热、头痛、呕吐、偏瘫,误诊为“化脓性脑膜炎、脑脓肿”2例。现将典型病例分析如下。 例1,女,17岁。头痛、恶心、呕吐2天入院。入院前10天鼻塞、流涕。近2天来感全头胀痛,伴恶心呕吐,发热。体检:意识清,精神萎。T:38.2℃。浅表淋巴结不肿大。腹(-)。神经科检查:瞳孔等大等圆,直径3mm。眼底示早期水肿。四肢肌力V°。颈稍有抵抗,克布氏征(±)。双Babinski’s征(+)。理化检查:WBC 10.2×10~9/L,N 0.84。ESR 26mm/h。Csf:无色,清,压力3.92kPa。潘氏试验(+),细胞数0.19×10~9/L,单核0.71。
In our hospital from 1978 to 1995, 171 cases of tuberculous meningitis were admitted, including 21 cases (12.3%) misdiagnosed, 15 cases of sporadic encephalitis misdiagnosed as sporadic encephalitis due to headache and vomiting after a cold or diarrhea, fever, headache, joint pain, ESR misdiagnosed as “rheumatic fever” in 4 cases; fever, headache, vomiting, hemiplegia, misdiagnosed as “purulent meningitis, brain abscess” in 2 cases. Now the typical case analysis is as follows. Example 1, female, 17 years old. Headache, nausea, vomiting 2 days admitted. 10 days before admission stuffy nose, runny nose. Nearly 2 days to feel the whole head pain, with nausea and vomiting, fever. Physical examination: conscious, spiritual wilting T: 38.2 ° C. Superficial lymph nodes are not enlarged. belly(-). Neurology examination: Pupil and other large circle, diameter 3mm. Fundus showed early edema. Limb muscle strength V °. Neck slight resistance, Kebu’s sign (±). Double Babinski’s sign (+). Physical and chemical examination: WBC 10.2 × 10 ~ 9 / L, N 0.84. ESR 26mm / h. Csf: colorless, clear, pressure 3.92kPa. Pan test (+), cell number 0.19 × 10 ~ 9 / L, mononuclear 0.71.