Clinical Analysis Of 95 Adult Tuberculous Meningitis

ObjectiveTo explore the early clinical features of tuberculous meningitis,cerebrospinal fluid changes,laboratory tests,imaging features,treatment options and outcomes,in order to improve the clinician's ability to diagnose and treat the disease.MethodsThe clinical data of 95 cases which were firstly diagnosed as tuberculous meningitis in the First Affiliated Hospital of Nanchang University from January 2012 to September 2017 were retrospectively analyzed.ResultsThe 95 patients in this group were aged 15-79 years and the ratio of male to female was 1.32:1.The time from onset of illness to our hospital was 4 to 90 days,with acute and subacute onset(94.7%).The main clinical symptoms contained fever,headache,nausea with vomiting and meningeal irritation.Atypical symptoms include obstruction,weight loss,fatigue,night sweats,and mental and behavioral disorders.The hospital admissions were mainly stage II(57.9%)and stage III(29.5%).The number of nucleated cells in cerebrospinal fluid was 10-500*106/L(69.4%),protein was increased in 1000-400 mg/L(78.9%),and sugar and chloride reduction ratios were 56.8% and 83.2% respectively.The positive rate of T-SPOT of peripheral blood was 56%.The positive rate of MRI in cranial imaging examination(70.2%)was higher than that in CT(45.5%).Meningeal enhancement,cerebral infarction,tuberculoma,hydrocephalus and other changes were more obvious.In all cases,82 patients were improved,12 patients were deteriorated and 1 patient was died.ConclusionIn this study,adult tuberculous meningitis is more common in middle-aged and older people,and the staging of the disease at the time of admission helps to determine the prognosis.Diversification of clinical symptoms and imaging changes,early lack of specific changes in cerebrospinal fluid,the detection rate of etiology is low.Clinicians should pay attention to the atypical clinical manifestations of TBM,dynamic observation of cerebrospinal fluid and imaging changes,combined with comprehensive analysis of patients' conditions to improve the diagnosis and treatment of TBM,early diagnosis and timely treatment is the key to improve the prognosis of the disease.