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目的探讨脑多发性结核瘤的临床、脑脊液细胞学和病理特点。方法回顾性分析2000年11月至2005年5月我院诊治的脑多发性结核瘤11例。结果患者临床上以发热和头痛起病,脑膜刺激征4例,意识障碍5例,偏瘫3例,抽搐2例。脑脊液压力升高8例,脑脊液蛋白升高10例,糖减低7例。脑脊液常规白细胞计数正常7例,升高4例;脑脊液细胞学见4例呈混合性细胞反应,2例呈淋巴-单核细胞反应,3例未见异常。11例头MRI均显示脑内多发结节或占位性病变,11例强化明显。5例开颅脑活检证实为结核性肉芽肿,抗酸染色阳性3例。结论脑内多发性结核瘤是一种特殊类型的颅内结核感染,综合其临床表现、影像学和脑脊液细胞学等特点有助于临床诊断。
Objective To investigate the clinical and cerebrospinal fluid cytological and pathological features of multiple brain tuberculosis. Methods Retrospective analysis of 11 cases of multiple brain tuberculosis diagnosed and treated in our hospital from November 2000 to May 2005. Results Patients with fever and headache clinically onset, meningeal irritation in 4 cases, 5 cases of disturbance of consciousness, hemiplegia in 3 cases, convulsions in 2 cases. Cerebrospinal fluid pressure increased in 8 cases, cerebrospinal fluid protein increased in 10 cases, sugar decreased in 7 cases. Cerebrospinal fluid routine white blood cell count was normal in 7 cases, elevated in 4 cases; cerebrospinal fluid cytology in 4 cases were mixed cell response, 2 cases were lymphatic - mononuclear cell response, 3 cases no abnormalities. 11 cases of head MRI showed multiple intracranial nodules or space-occupying lesions, 11 cases were significantly enhanced. 5 cases craniotomy biopsy confirmed tuberculous granuloma, acid-fast staining in 3 cases. Conclusions Multiple intracranial tuberculomas are a special type of intracranial tuberculosis infection. Clinical features, imaging and cerebrospinal fluid cytology can be helpful for clinical diagnosis.