关键词: 结核,脑膜, 脑梗死, 磁共振成像, 危险因素

Abstract:

Objective: To analyze the clinical characteristics and the risk factors of acute cerebral infarction in patients with intracranial tuberculosis. Methods: A retrospective study was conducted to collect 84 patients with positive cultures of Mycobacterium tuberculosis in cerebrospinal fluid admitted to the Kuming Third People’s Hospital of Kunming from July 2019 to December 2021. The clinical symptoms, laboratory test results and imaging findings of these study subjects were collected; based on the cranial magnetic resonance imaging (MRI) performance, these study subjects were divided into cerebral infarction group (32 cases, 38.1%) and non-cerebral infarction group (52, 61.9%). Univariate and multivariate logistic regression were used to analyze the risk factors of intracranial tuberculosis complicated with acute cerebral infarction. Results: Commonly clinical symptoms of intracranial tuberculosis included headache (95.2%,80/84), fever (73.8%,62/84), vomiting (52.4%,44/84) and unconsciousness (48.8%,41/84). The convulsions (7.1%,6/84) was rare. The peripheral blood magnesium concentration (median (interquartile)) of 0.80 (0.75, 0.85) mmol/L (normal value 0.73-1.06 mmol/L) in the non-cerebral infarction group was significantly lower than that of 0.84 (0.81, 0.89) mmol/L in the cerebral infarction group, and the difference was statistically significant (Z=2.079, P=0.038). In the cerebral infarction group, cranial MRI showed thickened meninges in the basal/annular cistern in 31 cases (96.9%), thickened meninges in the lateral fissure cistern in 21 cases (65.6%), and combined with thickened arterial vessel walls in 31 cases (96.9%). In the non-cerebral infarction group, cranial MRI showed thickened meninges in the basal/annular cistern in 26 cases (50.0%), thickened meninges in the lateral fissure cistern in 18 cases (34.6%), and combined with thickened arterial vessel walls in 28 cases (53.8%). The incidence of basal/annular cistern meningeal thickening, lateral fissure cistern meningeal thickening and arterial vessel wall thickening were significantly higher in the cerebral infarction group than in the non-cerebral infarction group, with significant differences (χ²=19.956,P=0.000;χ²=7.659,P=0.006;χ²=17.545,P=0.000). Multivariate logistic regression analysis showed that arterial vessel wall thickening might be an independent risk factor for intracranial tuberculosis combined with acute cerebral infarction (OR (95%CI)=27.128 (3.393-216.917)). Conclusion: The common clinical symptoms of intracranial tuberculosis included headache, fever, vomiting and unconsciousness, and the MRI result showed that thickening of the arterial vessel wall might be an independent risk factor for acute cerebral infarction.

Key words: Tuberculosis, meningeal, Brain infarction, Magnetic resonance imaging, Risk factors