颅内结核误诊为颅内转移性恶性肿瘤一例.pdfVIP

‘fl，临床误诊误治却叫 ·误诊研究:感染性疾病· 颅内结核误诊为颅内转移性恶性肿瘤一例 江丽萍 [摘要] 目的 探讨颅内结核的临床特点，分析其误诊原因并提出防范措施。方法 回顾性分析颅内结核误诊为颅内 转移性恶性肿瘤 l 例的临床资料。结果 本例因低热、腹痛 3 个月，右侧肢体元力、言语不清 1 个月入院。外院正电子发射 计算机断层显像(PET)-CT 提示右半结肠癌伴双肺转移、脑转移。予相应治疗后无好转来我院，经影像学检查、脑脊液检查、 结核杆菌 DNA 检测后确诊为结核性脑膜炎、肺结核、肠结核，予全身抗结核、脑脊液置换及对症治疗后，病情好转出院。结论 对于颅内结核，临床医生应认真仔细询问患者病史和细致查体，并及时行脑脊液检查和结核分枝杆菌 DNA 检测，以避免 误诊的发生。 [关键词] 结核瘤，颅内;误诊;肿瘤，恶性，转移性 [中国图书资料分类号] 盯29.3 [文献标志码1 A [文章编号1 1∞2-3429(2013) 11 -000 1-02 [DOI] 10. 3969/j. issn.l∞2-3429.2013. 1 1.∞1 Intracranial Tuberculosis Misdiagnosed as Intracranial Metastatic Cancer: A Case Report JIANG Li-ping (Department of Tuberculosis , Fuzhou General Hospital of Nanjing Military Area Command , Fuzhou 35αlO3 ， China) [ Abstract] 0时ective To explore clinical features of intracranial tuberculosis , and analyze the misdiagnosed causes to pro- pose the preventive measur，臼. Methods Clinical data of a patient with intracranial tuberculosis misdiagnosed as having intracranial metastatic cancer was retrospectively analyzed. Results The patient was admitted for low-grade fever and abdominal pain for 3 months , weakness of right limbs and slurred speech for 1 month. The positron emission computed tomography (PET) and CT exami- nation in another hospital showed right hemicolon cancer with hibateral pulmonary and brain metastases. The patient was transferred to our hospital after corresponding treatments failed. The patient was confirmed as having tubercular meningitis , pulmonary tubercu- losis and intestinal tuberculosis by iconography examinations , examination of cerebrospinal fluid and tubercle bacillus DNA examina- tion. The patient was then discharged after symptoms were alleviated by systemic ànti-tuberculosis , cerebrospinal fluid replacement and symptomatic treatment. Conclusion Clinicians should carefully ask of the medical histor