关键词: 结核, 中枢神经系统, 脑动脉, 疾病特征

Abstract:

Objective: To explore the clinical characteristics of central nervous system tuberculosis complicated with cerebral arteritis, and to improve the understanding of it. Methods: The clinical data of 15 cases of central nervous system tuberculosis admitted to Hebei Chest Hospital from April 2019 to December 2021 were analyzed retrospectively. All patients underwent head MRI plain scan+MRI enhanced scan+cerebral magnetic resonance angiography (MRA). The basic data, disease history, clinical manifestations, results of laboratory and etiological examinations, and imaging characteristics of those patients were analyzed. Results: Fifteen patients with central nervous system tuberculosis were all complicated with tuberculosis in other organs, including 10 cases complicated with pulmonary tuberculosis, 2 cases with bone joint tuberculosis, 2 cases with tuberculous pleurisy, 1 case with lumbar tuberculosis, 3 cases with lymph node tuberculosis and 1 case with tuberculous retinopathy. The most common clinical manifestations in the early stage of onset were headache with fever (12 cases), allophasis, disorders of consciousness (3 cases), and even physical mobility impairment (1 case). Cerebrospinal fluid examination showed that the intracranial pressure increased in 12 cases (>200 mm H₂O), the protein level was significantly higher than normal in 11 cases, the leukocyte count increased in 9 cases (>100×10⁶/L), the glucose decreased in 8 cases and the chloride decreased in 7 cases. Among the 15 patients, 14 cases were found to be having intracranial artery stenosis by cranial MRA, and 13 cases had cerebral infarction. At the time of discharge, conditions of all patients were significantly improved, but 2 patients had obvious sequelae such as physical mobility and cognitive impairment. Conclusion: Central nervous system tuberculosis complicated with endarteritis can lead to cerebral infarction, which often involves the branches of perforating branches and terminal branches of the cerebral cortex, and can also lead to intracranial artery stenosis. Therefore, in the course of diagnosis and treatment, vascular and neuroprotective therapy shall be provided at early stage.

Key words: Tuberculosis, Central nervous system, Cerebral arteries, Disease attributes