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结核性脑膜炎是由结核杆菌引起的脑膜非化脓性炎症,常继发于粟粒结核或其他脏器结核病变。主要病理变化是在软脑膜°和蛛网膜上有结核结节形成,病灶周围有炎症和纤维蛋白°性渗出物,并有干酪样坏死,常以脑底部最为明显。在蛛网°膜下腔内,有多量的黄色混浊胶样渗出物积聚,主要由浆°液、纤雏素、巨噬细胞、淋巴细胞组成。围绕脑干,可压迫和损害就近的脑神经,引起相应的脑神经受损症状。病变严重者可累及脑皮质而引起脑膜脑炎、多发性脑软化。未经适当治疗而致病程迁延的病例,由于蛛网膜下腔渗出物的机化而发生蛛网膜粘连,可使第四脑室下中孔和外侧孔阻塞,引起脑积水。
Tuberculous meningitis is caused by the Mycobacterium tuberculosis non suppurative inflammation, often secondary to miliary tuberculosis or other organ tuberculosis. The main pathological changes are tuberous tubercle formation at the aponeurosis and arachnoid, inflammation and fibrinous exudate around the lesion, and casein-like necrosis, most often at the bottom of the brain. In the cobweb submucosa, there is a large amount of yellow cloudy gel exudate accumulation, mainly by the pulp liquid, fibronectin, macrophages, lymphocytes. Around the brainstem, can compress and damage the nearby brain, causing the corresponding brain damage symptoms. Serious lesions can affect the cerebral cortex and cause meningoencephalitis, multiple brain softening. Without appropriate treatment and pathological course of delay cases, due to the subarachnoid exudate and the occurrence of arachnoid adhesions, the fourth ventricle can cause obstruction of the middle and lateral holes, causing hydrocephalus.