TUBERCULOUSMENINGITIS结核性脑膜炎LongnanHospitalChenjing第一页，共六十八页。•Tuberculousmeningitisisaninfectionofthemembranes膜coveringthebrainandspinalcord(meninges).•Tuberculosis(TB)iscausedbythebacteriumMycobacteriumtuberculosis结核分枝杆菌andisannuallyresponsiblefornearlytwomilliondeathsworldwide.•Athirdoftheworld'spopulationiscurrentlyinfectedwiththeTBbacillus,andmorethaneightmillionnewcasesdidh第二页，共六十八页。•Tuberculousmeningitismustbeconsideredinpatientswhopresentwithaconfusionalstate,especiallyifthereisahistoryofpulmonarytuberculosis,alcoholism,corticosteroidtreatment,HIVinfection,orotherconditionassociatedwithimpairedimmuneresponses.第三页，共六十八页。•Itshouldalsobeconsideredinpatientsformareas(eg,Asia,Africa)orgroups(eg,thehomelessandinner-citydrugusers)withahighincidenceoftuberculosis.第四页，共六十八页。Causes•Riskfactorsincludeahistoryof:AIDSExcessivealcoholusePulmonarytuberculosisWeakenedimmunesystem第五页，共六十八页。第六页，共六十八页。第七页，共六十八页。第八页，共六十八页。Pathogenesis&Pathology发病机制&病理•Tuberculousmeningitisusuallyresultsfromreactivationoflatentinfectionwithmycobacteriumtuberculosis.•结核性脑膜炎多是由于潜伏的结核杆菌复发感染引起的。第九页，共六十八页。Primaryinfection,typicallyacquiredbyinhalingbacilluscontainingdroplets,maybeassociatedwithmetastaticdisseminationofblood-bornebacillifromthelungstothemeningesandsurfaceofthebrain.Heretheorganismsremaininadormantstateintuberclesthatcanruptureintothesubarachnoidspaceatalatertime,resultingintuberculousmeningitis.原发性感染，尤其是通过吸入含菌颗粒引起的感染，可能与血源性细菌从肺部到脑膜及大脑外表的播散有关。此处的致病菌在结核结节中处于休眠状态，后期可破入蛛网膜下腔，并导致结核菌性脑膜炎。第十页，共六十八页。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。•Themainfindingisabasalmeningealexudate渗出物containingprimarilymononuclearcells.•Tuberclesmaybeseenonthemeningesandsurfacesofthebrain.第十一页，共六十八页。•Theventriclemaybeenlarged...
