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目的 分析中枢神经系统结核病的临床表现、病理特征及其误诊的原因。方法 对 2 70例中枢神经系统结核病患者进行回顾性调查 ,并对其中 32例经尸解病理证实的患者进行分析。结果 临床表现除脑膜刺激征、颅高压外尚有中枢神经系统局灶损害症征。死亡 6 1例 (占 2 2 .5 9% ) ,颅高压是其主要的死因。尸检发现以脑膜病变为主 ,大脑实质、小脑、脑干、脑室及脑血管和脊髓均有病变。误诊 49例 ,其中生前误诊 32例 ,总误诊率为 18.15 %。结论 中枢神经系统结核病的临床表现和预后与结核的病变性质和部位密切相关 ,认识其临床病理分型有助于提高诊断率。
Objective To analyze the clinical manifestations, pathological features and causes of misdiagnosis of central nervous system tuberculosis. Methods A retrospective study was conducted on 270 cases of central nervous system tuberculosis patients and 32 of them were confirmed by autopsy. Results Clinical manifestations in addition to meningeal irritation, there is still outside the CNS focal lesions of central nervous system symptoms. 61 cases of death (accounting for 22.59%), intracranial hypertension is the main cause of death. Autopsy found mainly to meningeal lesions, brain parenchyma, cerebellum, brainstem, ventricular and cerebrovascular and spinal cord lesions. 49 cases were misdiagnosed, of which 32 cases were misdiagnosed before birth, the total misdiagnosis rate was 18.15%. Conclusion The clinical manifestations and prognosis of tuberculosis in the central nervous system are closely related to the nature and location of the lesions in the tuberculosis. Recognizing the clinicopathological classification of the disease can improve the diagnosis rate.