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目的 分析结核性脑膜炎临床误诊原因，纠正误诊方法。方法 回顾性分析2022年3至10月1例初诊为急性支气管炎、1例初诊为多发腔隙性脑梗死的结核性脑膜炎患者的临床资料。结果 1例因间断发热10 d入院。胸部CT示肺纹理增粗，初步诊断为急性支气管炎，经抗感染治疗7 d后出院。约10 d后再次发热，多次就医未明确诊断，后出现呕吐、嗜睡等症状。再次入院时，腰椎穿刺检查示脑脊液压力偏高、蛋白含量较高，诊断为结核性脑膜炎，误诊时间为65 d。予以抗结核治疗，体温逐步恢复正常，3个月后病情稳定出院，继续抗结核治疗2年停药，观察至今病情稳定。1例因反复头晕20 d，加重伴呕吐3 d就诊，经头颅磁共振成像检查诊断为多发腔隙性脑梗死，对症治疗无效。入院后查体见共济失调、戈登征阳性，诊断为良性阵发性眩晕，复位治疗后无改善。后出现抽搐、意识障碍，颈抵抗阳性。脑脊液检查示蛋白升高、葡萄糖降低，抗酸染色阳性，确诊结核性脑膜炎，误诊时间为20 d。予抗结核及糖皮质激素治疗，症状缓解。疗程2年，随访无复发。结论 部分结核性脑膜炎患者临床症状不典型，易误诊，临床应提高诊断准确性，避免误诊，确保患者得到及时有效治疗。
Abstract：Objective To analyze the causes of clinical misdiagnosis of tuberculous meningitis and to correct the methods of misdiagnosis. Methods The clinical data of 2 patients with tuberculous meningitis initially diagnosed as acute bronchitis and multiple lacunar cerebral infarction respectively from March to October 2022 were retrospectively analyzed. Results One patient was admitted due to intermittent fever for 10 d. Chest CT showed lung texture thickening, and the initial diagnosis was acute bronchitis. The patient was discharged after 7 d of anti-infective treatment. About 10 d later, fever recurred, and the diagnosis was not clear after repeated visits to doctors. Then, vomiting and lethargy occurred. On re-admission, lumbar puncture showed high cerebrospinal fluid pressure and high protein content, and the patient was diagnosed with tuberculous meningitis. The duration of misdiagnosis was 65 d. After anti-tuberculosis treatment, the body temperature gradually returned to normal. Three months afterwards, the patient was discharged with stable condition, and the anti-tuberculosis treatment was continued for 2 years, and medication was stopped. The patient's condition has been stable since observation. One patient was admitted due to recurrent dizziness for 20 d, which was aggravated with vomiting for 3 d. She was diagnosed as multiple lacunar cerebral infarction by head MRI examination, and symptomatic treatment was ineffective. After admission, physical examination showed ataxia and Gordon's sign that was positive. The diagnosis was benign paroxysmal vertigo, and there was no improvement after reduction treatment. Afterwards, he developed convulsions, disturbance of consciousness, and positive neck resistance. Cerebrospinal fluid examination showed increased protein, decreased glucose, and positive acid-fast staining. Tuberculous meningitis was diagnosed, and the misdiagnosis lasted 20 d. After anti-tuberculosis and glucocorticoid treatment, the symptoms were relieved. After 2 years of treatment, there was no recurrence. Conclusion The clinical symptoms of some patients with tuberculous meningitis are atypical, which is more likely to be misdiagnosed. Clinical diagnosis accuracy should be enhanced to avoid misdiagnosis and ensure timely and effective treatment for patients.
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基本信息:
DOI：
中图分类号:R529.3
引用信息:
[1]吕志超,孟源源.结核性脑膜炎临床误诊分析[J].临床误诊误治,2025,38(16):7-11.
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