| Objective:To analyze the clinical features of tuberculous meningitis, and to screen the risk factors associated with the prognosis.Methods:Clinical data of 45 patients with tuberculous meningitis,20 patients with viral meningitis,15 patients with cryptococcal meningitis and 15 patients with purulent meningitis, in Zhejiang Provincal People’s Hospital from January 2013 to December 2015 were analyzed retrospectively. The clinical features about tuberculous meningitis and other three groups of meningitis were compared, including the combination of other diseases or underlying diseases, onset form, symptoms and signs of the patients, the results of cerebrospinal fluid examination, imaging performance, etc. Subsequently we explored the risk factors for the prognosis of tuberculous meningitis. First we studied single factor correlation analysis of the factors that may influence the prognosis of tuberculous meningitis (chi-square or t-test), then made the relevance of single factor into Binary multivariate logistic regression model for multivariate analysis.Results:1. In 45 cases of tuberculous meningitis,31 cases were complicated with other diseases or underlying diseases, accounting for 68.9%, including 23 cases of pulmonary tuberculosis,6 cases of pulmonary tuberculosis,6 cases of AIDS.2. There were 95 cases of central nervous infection in the study. The onset form was acute in 44 cases (46.3%), subacute in 37 cases (38.9%), and chronic in 14 cases (14.8%). Viral meningitis and purulent meningitis were mainly in acute onset, partial in subacute. Tuberculous meningitis and cryptococcal meningitis could have acute, subacute or chronic onset, and tuberculous meningitis was mainly in subacute or chronic onset.3. The main clinical manifestations of tuberculous meningitis were showed in order: fever (45,100%), headache (29,64.4%), nausea and vomiting (27,60%), cough (11,24.4%), disturbance of consciousness (11,24.4%), stiff neck (39,86.7%), positive Kernig sign (18,40%), positive Brudzinski’s sign (18,40%), positive Babinski sign (15,33.3%), cranial nerve damage (15,33.3%), the abducens nerve involvement was the most common (13.3%), followed by facial nerve and oculomotor nerve.4. Characteristics of cerebrospinal fluid in patients with tuberculous meningitis:Cerebrospinal fluid pressure:there was significant difference between tuberculous meningitis and viral meningitis (P<0.01). Compared with viral meningitis, the mean value of cerebrospinal fluid pressure in tuberculous meningitis was higher, the difference between tuberculous meningitis and cryptococcal meningitis or purulent meningitis was not statistically significant.Cerebrospinal fluid leukocyte count, adenosine deaminase and protein content:Four groups had varying degrees of increase, leukocyte count of purulent meningitis increased significantly, there was significant difference between tuberculous meningitis and purulent meningitis (P<0.01), and compared with purulent meningitis, cerebrospinal fluid leukocyte count of tuberculous meningitis was low, but difference between tuberculous meningitis and viral meiningitis or cryptococcal meningitis was not statistically significant (P>0.05); adenosine deaminase in tuberculous meningitis group increased significantly, and compared with other three groups, there was significant difference (P<0.01); protein content of purulent meningitis increased significantly, viral meningitis had the lowest mean value, there was significant difference between tuberculous meningitis and viral meningitis (P<0.01), compared with viral meningitis, the protein content in cerebrospinal fluid of tuberculous meningitis was higher, but differences between tuberculous meningitis and cryptococcal meningitis or purulent meningitis was not statistically significant (P>0.05).Cerebrospinal fluid glucose and chloride content:the mean value of Cerebrospinal fluid glucose and chloride content in viral meningitis roughly in the normal range, while other three groups were lower than the normal value. There was significant difference between tuberculous meningitis and viral meningitis or purulent meningitis (P<0.01). Compared with viral meningitis, cerebrospinal fluid glucose content of tuberculous meningitis was low, and compared with purulent meningitis, cerebrospinal fluid glucose content of tuberculous meningitis was hither, but difference between tuberculous meningitis and cryptococcal meningitis had no statistical significance (P>005); cerebrospinal fluid chloride content of tuberculous meningitis decreased most obviously, difference between tuberculous meningitis and viral meningitis or purulent meningitis had significant difference (P<0.01), compared with viral meningitis or purulent meningitis, cerebrospinal fluid chloride content of tuberculous meningitis was lower and difference between tuberculous meningitis and cryptococcal meningitis had no statistical significance (P>0.05).5. Imaging manifestations of tuberculous meningitis:In 45 patients,38 (84.4%) were examined by pulmonary CT, of which 25 (65.8%) were found to have abnormal. Specifically:15 cases of old pulmonary tuberculosis,8 cases of miliary pulmonary tuberculosis,1 case of interstitial pneumonia,1 case of silicosis. Other three groups of patients with pulmonary CT examination showed no obvious abnormalities.The abnormal rate of brain CT or MRI in tuberculous meningitis was higher (> 50%), the difference between tuberculous meningitis and cryptococcal meningitis or purulent meningitis in the abnormal rate was not statistically significant (P>0.05). Tuberculous meningitis and viral meningitis had significant difference in the brain parenchyma abnormality rate (P<0.0\), compared with viral meningitis, tuberculous meningitis with cerebral parenchymal abnormal rate was higher, but the difference between tuberculous meningitis and cryptococcal meningitis or purulent meningitis in brain parenchyma abnormality rate was not statistically significant (P>0.05). There was no significant difference between tuberculous and other three groups in the abnormal rate of the dural and cerebral ventricles (P>0.05).6. Study of the prognosis of tuberculosis meningitis found that age, conscious disturbance, severe abnormal electroencephalogram, hydrocephalus, significantly increased cerebrospinal fluid protein (≥236mg/dl) and cerebrospinal fluid white blood cell count (≥243 个/μl) might relevant with prognosis. By multivariate logistic regression analysis there only age, hydrocephalus were associated risk factors affecting prognosis of tubercular meningitis.Conclusions:1. Tuberculous meningitis is often complicated with pulmonary tuberculosis and extrapulmonary tuberculosis. AIDS, diabetes and hypertension are more common as underlying diseases.2. The onset form of tuberculous meningitis is diverse, it could have acute, subacute and chronic onset, but the subacute and chronic onset are more common.3. Fever, headache, nausea and vomiting in patients with unknown causes, with signs of tuberculosis poisoning symptoms and infection of the central nervous system, we should consider the possibility of tuberculous meningitis, and make the timely cerebrospinal fluid examination.4. The characteristic changes of cerebrospinal fluid in patients with tuberculous meningitis are the increase of lymphocyte and protein content, the decrease of glucose and chloride content, and the increased value of ADA (≥4 U/L) is more valuable in the diagnosis of tuberculous meningitis.5. Brain parenchymal changes are the most common manifestations of tuberculous meningitis, and the CT or MRI of the brain is important for the diagnosis of tuberculous meningitis.6. Age and hydrocephalus are risk factors for the prognosis of tuberculous meningitis. |
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