[Clinical and pathological manifestations in 129 patients with tuberculous meningitis]

To investigate the diagnosis of tuberculous meningitis.

One hundred twenty-nine cases of tuberculous meningitis proved by autopsy, from the year 1952 through 1994, were retrospectively reviewed.

Sixty-four cases were misdiagnosed before death, and the misdiagnosis rate was 49.6%. Among these misdiagnosed cases, 34 were misdiagnosed as other brain diseases, and the other 30 cases were misdiagnosed as severe pulmonary tuberculosis, severe pneumonia, gastric cancer, rheumatic heart disease, cor pulmonale and leukemia, etc. The main clinical manifestations included meningitis and extra-cerebral tuberculous syndromes. The cerebral spinal fluid changes included pressure increase, elevation of cell counts and protein content, decrease of glucose and chlorides. Both cerebral CT and intensified scan showed miliary tubercles in the brain parenchyma. High density stellate type of shadows in the basal surface of the brain, interpedunclar forsa and cerebral fissures, enlargement of brain ventricles, cerebral edema and thrombosis were also shown. Tuberculous lesions in the meninges, brain parenchyma, brain ventricles and brain blood vessels were found by autopsy.

The clinical manifestations, cerebral spinal fluid examination, in combination with CT scan of the head, and searching for extracerebral tuberculous foci are the basis for the diagnosis of tuberculous meningitis.