The clinical and cerebrospinal fluid cytological features of tuberculous meningitis

Abstract

Objective To analyze the clinical and cerebrospinal fluid (CSF) cytological features of patients with tuberculous meningitis (TBM), to improve early diagnostic accuracy and treatment of TBM. Methods Clinical presentations, etiology and biochemical and cytological features of CSF were analyzed retrospectively among 60 adult cases with TBM hospitalized at Neurology Department of General Hospital of Ningxia Medical University from January 2005 to May 2011. Results Most patients (58/60, 96.67%) had fever and headache at onset. In some patients, disturbance of consciousness (9/60, 15.00%), seizure (5/60, 8.33%) occurred in 1 week and focal neurological signs developed during the course. Forty⁃four patients (73.33%) had pulmonary tuberculosis history. In CSF examination, acid⁃fast bacillus positive was found in 8 patients. Positive acid ⁃ fast myobacterium tuberculous culture was detected in 5 patients and positive myobacterium tuberculosis DNA were seen in 5 patients. The main changes of CSF were intracranial hypertension, increase of protein, and decrease of glucose. CSF presented mixed cellular response with predominace in the increasing of leucocytes. During early stage the mean percentage of neutrophil in CSF was less than 40%. After short term (as long as 2 months) of regular antituberculotic therapy no significant changes in total cell count and the proportion of neutrophils were seen. In 60 patients, 44 patients were ameliorated, 11 were not healed or were discharged or transferred to other hospital and 5 were dead. Prognosis of patients treated within 3 weeks after onsets was superiorly to those treated at more than 3 weeks after onset. Conclusion There are no specific clinical features in TBM and it is hard to perform early diagnosis for TBM, particularly, existing of low efficiency in pathogenic detection, but pulmonary tuberculosis is of accessary value to diagnose TBM. Whereas mixed cellular response may complementarily provide the diagnosis of TBM in early stage. Cytologic changes of CSF can be very slow even after therapy. Therefore persistent mixed cellular response in CSF cannot exclude TBM. The time of treatment will determine the therapeutic effectiveness in a great degree.

DOI：10.3969/j.issn.1672⁃6731.2012.02.021