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作者报告1例罕见的结核性脑膜炎(TBM)后脊髓及延髓空洞症患者。患者40岁,因持续发热和盗汗四年,口服抗结核药无效而住院。检查:颈强硬,CSF:蛋白;460mg%、白细胞5960/ml、红细胞53/ml,糖0.8mmol/l(血糖8.1mmol/l),未找到致病菌。头颅CT显示:多发性环状密度区、侧脑室壁密度影及轻度脑积水,诊断为TBM伴多发性结核瘤。用异烟肼、利福平、吡嗪酰胺、地塞米松和维生素B_6治疗,初病情有所改善,但四周后意识程度恶化,复查CT显示:脑积水增加,经右侧脑室腹膜分流术后,很快恢复,术中活检标本发现肉芽肿,而无致病菌。抗结核治疗18个月,患者出现了轻度周围神经病。停止治疗后6个月,出现上肢乏力,腱反射消失,一月后发现患者右手冷热觉消失,检查除上
The authors report a rare case of tuberculous meningitis (TBM) posterior spinal cord and bulbar syndrom. The patient, 40, was hospitalized for persistent fever and night sweats for four years, and oral anti-TB drugs were ineffective. Check: neck hard, CSF: protein; 460mg%, white blood cells 5960 / ml, erythrocyte 53 / ml, sugar 0.8mmol / l (blood sugar 8.1mmol / l), did not find pathogens. Head CT showed: multiple annular density, lateral ventricular wall density and mild hydrocephalus, diagnosis of TBM with multiple tuberculosis. With isoniazid, rifampin, pyrazinamide, dexamethasone and vitamin B_6 treatment, the initial condition has improved, but after four weeks of deterioration in consciousness, review of CT showed: hydrocephalus increased right ventricle peritoneal shunt After the rapid recovery, intraoperative biopsy specimens found granuloma, without pathogenic bacteria. Anti-TB treatment for 18 months, patients with mild peripheral neuropathy. Six months after stopping treatment, the upper extremity was weak and the tendon reflex disappeared. After one month, the patient’s right hand cold and heat disappeared,