Tuberculous meningitis is caused by Mycobacterium tuberculosis meningeal non-suppurative inflammation. Often secondary to other organs miliary tuberculosis or TB change. Children in the past Most of the regular primary pulmonary syndrome disseminated the results of blood or body part of the SU-TB. Adult incidence rate of more than half, with a higher prevalence among young people, but also can be found in old age. In addition to tuberculosis, bone and joint TB genitourinary system TB is often the source of blood spread. Some cases can also be due to brain or meningeal TB lesions in the liquefied Kuipo so that the large number of TB bacilli into the subarachnoid due. Tuberculous meningitis is the main pathological changes in leptomeningeal and spinal tuberculosis on nodule formation, inflammation and lesions around the fibrin of exudative, and cheese necrosis, often at the bottom of the most obvious. In subarachnoid, the number of yellow plastic-like opacity exudation of accumulation, mainly by the size, cellulose, macrophages and lymphocytes components. Around the brain stem, oppression and cranial nerve damage to the nearest caused cranial nerve damage to the corresponding symptoms. Serious diseases involving cerebral cortex may be caused meningoencephalitis, caused multiple brain softening. Without proper treatment of disease caused protracted cases, because of a subarachnoid exudation of the machine in case of spinal adhesions, will enable the fourth ventricle of the lateral hole in the hole and obstruction caused hydrocephalus. According to the clinical and pathological, tuberculous meningitis can be divided into four types:
Meningeal type: high intracranial pressure and meningeal irritation levy as the main performance.
TB brain tumor type: lesions in the brain, a brain-targeted focal signs and symptoms, such as epilepsy, such as single-paralysis.
Consisting mainly of spinal cord: this type of treatment for meningitis from improper change, but also is an incidence of this type, there are symptoms of nerve root or spinal paralysis, urinary incontinence, and so it.
Mixed: At the same time with this type of meningitis and tuberculosis of the brain-type features.
, points
History: the majority of patients newly infected with TB or have a history of tuberculosis or TB in close contact with history.
Symptoms: often 10 to 20 days of the precursor symptoms, such as mental vibration, general weakness, anorexia, emotional disturbance, easily excited, fever, nausea, vomiting, constipation, and so on. Gradually undergoing drowsiness, headache intensified, and a spray of vomiting, neck stiffness, such as increased intracranial pressure and meningitis stimulate the levy. Consciousness unclear, gradually entering a coma. At this point all the reflection disappeared, incontinence, pupil positioning, pulse rate, respiration irregular, eventually leading to death.
Signs: temperature in more than 38 ℃, with miliary tuberculosis, the body temperature of up to 40 ℃. Multi-lateral to the dark , the majority of allergic skin reaction scratches. Hang in children before the uplift. Early pupil because of photophobia reduced, while the expansion of advanced fixed and unresponsive to light or even disappear. Optic nerve paralysis can occur, blepharoptosis, diplopia. The vast majority of patients neck stiffness, pathological reflection of positive physiological reflection of weakening or disappearance.
Supplementary examination:
cerebrospinal fluid examination: increased pressure, a colorless, transparent or the appearance of ground glass-like, may also Chengqian yellow. Static 24-hour film could have formed. And the increased number of cell protein, sugar and chloride lower. Mycobacterium tuberculosis culture can be positive, the increase of anti-tuberculosis antibody, immunoglobulin increased.
fundus examination: on the retina may have tuberculosis nodules. As the nipple edema can be identified intracranial hypertension.
tuberculin test: positive diagnosis of the reference value, but also can not rule out the possibility that negative tuberculous meningitis.
X-examination: lung X-ray examination found the original of the syndrome, active tuberculosis, especially miliary tuberculosis, contribute to the diagnosis of tuberculous meningitis.
CT examination: a show of meningoencephalitis, brain lesions in the miliary tuberculosis of cheese and lesions, but also displayed at the bottom of the exudation of the brain, cerebral edema, expansion of ventricle. Of tuberculosis
Type of meningitis, after the judgement and guidance of the more significant.
, prevention and prognosis
Strengthen the training, enhanced physique, remained optimistic, Dr Yat moderate to strong and upright, to reduce the incidence.
Primary treatment of active tuberculosis, the elimination of TB lesions and prevent secondary infection.
Vaccination: BCG vaccination, not only to prevent the occurrence of tuberculosis, etc., and BCG vaccination in the neonatal period, the incidence of TB meningitis was significantly lower.
Has been suffering from tuberculosis for the meningitis patients, hospital treatment and hospital stay of not less than three to six months.
Poor prognosis of the disease, the mortality rate more than 15 percent. Good or bad prognosis of the main decisions on treatment and sooner or later the state of consciousness, consciousness disorder, the mortality rate increased significantly. In addition, the elderly, child mortality is also high.
