在结核性脑膜炎中发生中风血栓溶解
Pik Ee Chan1, Anamika Saha2, Tim Saunders2
1Geriatric medicine, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK chanpikee@gmail.com.
BMJ case reports
|January 19, 2025
概括
一个罕见的结核性脑膜炎 (TBM) 病例呈现为年轻女性缺血性中风. 及时诊断和使用抗结核药物和类固醇治疗导致了显著的临床改善.
科学领域:
- 神经学 神经学
- 传染性疾病 传染性疾病
- 在瘤学瘤学.
背景情况:
- 结核性脑膜炎 (TBM) 是一种严重的肺外结核病.
- 脑瘤可以呈现出各种神经症状,有时模仿其他疾病,如中风.
- 宫淋巴腺病变可能是传播结核病的指标.
研究的目的:
- 报告一种独特的结核性脑膜炎病例,呈现为缺血性中风.
- 突出诊断挑战和成功管理TBM.
- 强调在患有类似中风症状和淋巴腺病变的患者中考虑TBM的重要性.
主要方法:
- 一个30多岁的女性突然出现神经缺陷的病例报告.
- 最初的检查包括CT脑,CT血管图和NIHSS评分.
- 随后的调查包括头部的MRI和宫淋巴结活检.
- 治疗包括对疑似缺血性中风进行血栓溶解,然后进行抗结核疗法和类固醇.
主要成果:
- 患者最初呈现出与缺血性中风 (NIHSS 8) 一致的症状,在血栓溶解后得到改善.
- 经常出现神经系统恶化,发烧和发作.
- 核磁共振扫描显示了勒普托门腺增强,淋巴结活检证实了暗示TBM的粒状淋巴腺炎.
- 对缺血性中风和TBM的联合治疗导致了良好的临床康复.
结论:
- 结核性脑膜炎可以不典型地呈现为缺血性中风,这给诊断带来了挑战.
- 在成像和活检的支持下,早期识别TBM对于有效的管理至关重要.
- 针对中风和TBM组件的多模式治疗对于有利的结果至关重要.
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