An Unusual Case of Tuberculous Meningitis

結核性腦膜炎的非尋常臨床表現

邱百誼(Pai-Yi Chiu) ； 黃偉師(Wei-Shih Huang) ； 李正淳(Cheng-Chun Lee) ； 沈戊忠(Wu-Chung Shen)

《Mid-Taiwan Journal of Medicine》 6卷2期 (2001/06) Pp. 119-123

https://doi.org/10.6558/MTJM.2001.6(2).10

摘要

結核性腦膜炎的初始症狀通常是亞急性的頭痛，嘔吐，發燒，及精神不穩定。隨著疾病的演變，病人也常常產生失明，顱神經損害，以及局部神經受損症狀。單以複雜性局部癲癇為初始症狀在結核性腦膜炎是很少見的。本文報告一位以複雜性局部癲癇和回溯性失憶為初始症狀的成年結核生腦膜炎患者。本患者結核性腦膜炎的確診是經由陽性的結核聚合鏈反應和核磁共振掃描影像發現在基底池有廣泛的軟腦膜顯影並且向下延伸到脊髓。她接受了抗結核藥治療和腦脊髓液引流手術。在往後追蹤兩個月的期間並未再有癲癇發作且回溯性失憶正在逐漸恢復中。

關鍵字

複雜性局部癲癇 ； 軟腦膜 ； 聚合鏈反應 ； 回溯性失憶 ； 結核性腦膜炎

並列摘要

The onset of tuberculous meningitis is usually characterized by sub-acute headache, vomiting, fever, and bursts of irritability. With progression of the disease, blindness, signs of damage to other cranial nerves and focal neurological signs may commonly appear. Onset of the disease coupled with complex partial seizures alone is rarely seen in tuberculous meningitis cases. However, we present a case of tuberculous meningitis with onset symptoms of complex partial seizure followed by retrograde amnesia. The diagnosis of tuberculous meningitis was confirmed by polymerase chain reaction and the discovery of diffuse leptomeningeal enhancement in the basal cistern with downward extension to the spinal cord was made by magnetic resonance imaging. The patient received anti-tuberculous drug therapy and underwent external drainage. There were no further seizure attacks and the retrograde amnesia improved gradual1yduring two months of follow-up.

並列關鍵字

complex partial seizure ； leptomeningeal ； polymerase chain reaction ； retrograde amnesia ； tuberculous meningitis