关键词: 结核,脑膜, 诊断

Abstract: Objective To develop the differential diagnosis level for the tuberculosis meningitis (TM).Methods 38 patients were misdiagnosed to be TM in all of 342 patients who were diagnosed to be TM from Jan for 1985 to Oct of 2000.The 38 misdiagnosed TM patients were summarized and retrospectively analyzed.Results The overall missed rate was 11.1%(38/342).The differential diagnoses for the 38 missed patients were respectively virus meningitis 19 (50%),cryptococcus meningitis 7(18.4%),cerebral cysticercosis 3(8.0%),erythema lupus for brain 2(5.3%),acute disseminated encephalomyelitis 2(5.3%),cerebral abscess,cyst beside epiphysis,meningioma,gliocytoma,non-specific narrow of cerebral duct respectively 1(2.6%).The delayed time from 2 days to 360 days,the average was 37 days.Conclusion (1)Tuberculosis physician should know the clinical manifestation of other brain diseases,so that can develop the level of diagnosis or differential diagnosis for tuberculosis meningitis.(2)We should pay attention to these patients whose clinical manifestations and CSF tests are atypical,and the patients who are not effect to the anti-tuberculosis chemotherapy.For these patients,we should further differentiate it from cryptococcus meningitis and cerebral cysticercosis or other brain diseases.(3)The acute disseminated encephalomyelitis should be considered if the patient’s disease occurred urgently and progressed rapidly,or in the early stage occrurred consciousness obstruction,paraplegia and sphincter’s function failure,but the CSF changed slightly.(4)CT (especially concentration) or MRI tests for brain can play a very important role of diagnosis and differentiation for TM.

Key words: Tuberculosis,Meningitis, Diagnosis