CLINICAL OBSERVATION OF 12 CASES OF TUBERCULOUS MENINGITIS

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  • 結核性髄膜炎12例の臨床的観察
  • ケッカクセイ ズイマクエン 12レイ ノ リンショウテキ カンサツ

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Clinical analysis was made on 12 cases of tuberculous meningitis which have been experienced since 1962.<BR>The diagnosis o f tuberculous meningitis was made by autopsy in 5 cases, by the presence of tubercle bacilli in cerebrospinal fluid in 3 cases, and by the typical symptoms and signs in 4 cases.<BR>Four patients were male and eight were female. As to the age, only one case was oneyearold, one case from 10 to 19, 6 cases from 20 to 39, 2 cases from 40 to 59, and 2 cases more than 60.<BR>The previous history of tuberculosis was found in 5 cases; among them, 3 had previous tuberculosis 1 to 4 years before the onset of tuberculous meningitis, and in the other 2 cases the date of previous tuberculosis was unclear.<BR>Miliary tuberculosis was complicate d in 7 cases, pulmonaly tuberculosis in 3 cases, retinochorioiditis in 1 case, and renal tuberculosis in 1 case.<BR>Body temperature ranged 38.0°C to 38.9°C in 7, 39.0°C to 39.9°C in 4, and 40.0°C or over in 1. Headache was complained of in 9 out of 10 cases with clear consciousness, and nausea and/or vomiting in 3 cases. Central nerve system disturbance, convulsion and/or rigidity were observed in 5 cases.<BR>The cerebrospinal fluid findings in our cases were typical in the majority of cases, and tubercle bacilli in cerebrospinal fluid were positive in 6 cases.<BR>As to its pathogenesis, early dissemination was su g gested in only one case in which meningitis developed soon after primary tuberculosis, and late dissemination in 5 cases with previous history of tuberculosis before one year or more, and unclear in 6 cases.<BR>All cases were treated with antituberculous drugs, and corticosteroid was used in 11cases.<BR>The prognosis was good in 5 cases but 7 cases died. It was thought that the most imortant factor influencing the prognosis was the pretreatment degree of disturbance of the consciousness.<BR>In conclusion, tuberculosis meningitis in recent years was seen mostly in adults, developed by late dissemination, and the prognosis was not so good.

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