TUBERCULOUSMENINGITIS;Tuberculousmeningitisisaninfectionofthemembranes膜coveringthebrainandspinalcord(meninges).
Tuberculosis(TB)iscausedbythebacteriumMycobacteriumtuberculosis结核分枝杆菌andisannuallyresponsiblefornearlytwomilliondeathsworldwide.
AthirdoftheworldspopulationiscurrentlyinfectedwiththeTBbacillus,andmorethaneightmillionnewcasesarediagnosedeachyear.;Tuberculousmeningitismustbeconsideredinpatientswhopresentwithaconfusionalstate,especiallyifthereisahistoryofpulmonarytuberculosis,alcoholism,corticosteroidtreatment,HIVinfection,orotherconditionassociatedwithimpairedimmuneresponses.;Itshouldalsobeconsideredinpatientsformareas(eg,Asia,Africa)orgroups(eg,thehomelessandinner-citydrugusers)withahighincidenceoftuberculosis.;Causes;第六页，共六十八页。;第七页，共六十八页。;第八页，共六十八页。;PathogenesisPathology发病机制病理;Primaryinfection,typicallyacquiredbyinhalingbacilluscontainingdroplets,maybeassociatedwithmetastaticdisseminationofblood-bornebacillifromthelungstothemeningesandsurfaceofthebrain.
Heretheorganismsremaininadormantstateintuberclesthatcanruptureintothesubarachnoidspaceatalatertime,resultingintuberculousmeningitis.;主要发现是含有大量单核细胞的脑基底部脑膜分泌物。脑膜及脑外表可见结核结节。;Theventriclemaybeenlargedasaresultofhydrocephalus,andtheirsurfacesmayshowependymalexudateorgranularependymitis.
Arteritiscanresultincerebralinfarction,andbasalinflammationandfibrosiscancompresscranialnerves.
;Acutetuberculousmeningitiswithmarkedinvolvementofthevesselwallsandocclusionofsmallervessels.
Thevascularinvolvementcanresultininfarction.;第十四页，共六十八页。;第十五页，共六十八页。;ClinicalFindings;B.SIGNS;Complicationsincludespinalsubarachnoidblock脊髓蛛网膜下腔梗阻,hydrocephalus脑积水,brainedema脑水肿,cranialneverpalsies颅神经麻痹,andstrokecausedbyvasculitisorcompressionofbloodvesselsatthebaseofthebrain因血管炎或颅底血管受压导致的卒中.