结核性脊髓炎

　　结核性脊髓炎病原菌为结核杆菌。结核菌通过血行或直接侵入而累及脊髓、脊膜和脊髓血管，形成结核性肉芽肿或结核球，致脊膜、脊蛛网膜炎及脊髓缺血。胸腰段脊髓受累较多见。以脊髓内受累为主者，可为髓内单发或多发的结核肉芽肿或结核球，严重者可伴空洞形成；以脊膜受累为主者，常有脊膜及神经根增厚。此外尚有结核性脊膜炎或血管炎而继发脊髓血管受压或阻塞造成的脊髓缺血，产生脊髓缺血性损伤的病理改变。

　　结核性脊髓炎多见于青壮年，病前可有结核接触史或结核史。结核性脊髓炎可并发颅内压升高，出现恶心、呕吐、视乳头水肿、头痛等症状。

　　结核性脊髓炎多见于青壮年，病前可有结核接触史或结核史。具体的临床表现如下：
　　1、通常缓慢起病，在出现脊髓症状的同时有低热、纳差、消瘦、盗汗等。
　　2、脊髓损害常为不完全性，出现病变水平以下的肢体瘫痪、感觉障碍和大小便潴留。
　　3、当病变以脊膜、脊蛛网膜损害为主时，则以根痛为主要表现，并出现分散性、不对称性、节段性感觉障碍，临床表现颇似脊髓蛛网膜炎。

　　结核性脊髓炎的主要原则是增强体质，注意预防呼吸道传染；加强对结核病患者的管理与治疗；新生儿及儿童按要求积极实施计划免疫接种；早期综合治疗，减轻并发症和后遗症。此外，还要预防脊髓邻近组织感染累及脊髓。严格执行诊疗操作常规，预防由神经外科手术及诊疗操作所致的医源性感染。

　　The diagnosis of tuberculous myelitis not only relies on clinical manifestations but also requires related auxiliary examinations. The commonly used examinations in clinical practice are as follows:

　　First, blood routine examination
　　Generally normal, peripheral blood leukocyte count is normal or slightly elevated; erythrocyte sedimentation rate is elevated.

　　Second, cerebrospinal fluid examination
　　The number of cerebrospinal fluid cells is slightly increased, with tens to hundreds of white blood cells, mostly mixed type, with monocytes accounting for about 85%; protein content is slightly to moderately increased; sodium chloride and glucose are mostly decreased. Cerebrospinal fluid dynamic examination can find that the spinal canal is patent or partially blocked, with an appearance of opalescence, and a white fibrous film can be formed after several hours. This film is easily stained with acid-fast bacilli when directly stained with acid-fast stain.

　　Third, etiological evidence
　　1. The detection rate of cerebrospinal fluid bacterial smear and bacterial culture is low.
　　2. Skin tuberculin test.

　　Fourth, chest X-ray examination
　　Active or old tuberculous lesions can be seen. Some patients have spinal tuberculosis or tuberculous paraspinal abscess, and these patients' spinal X-rays show typical changes of spinal tuberculosis: vertebral body destruction, posterior curvature and angular deformity of the spine, and formation of paraspinal cold abscess.

　　Fifth, MRI manifestations of intramedullary tuberculosis
　　The involved spinal cord swells, and the tuberculoma is an isointense or hypointense lesion at T1, and a hyperintense lesion at T2. After injection of contrast agent, there is enhancement at the edge or nodular enhancement within the lesion. When the meninges and arachnoid are involved, MRI shows thickening of the lumbar nerve roots and disappearance of the subarachnoid space.

　　In addition to conventional treatment, dietary adjustments are also needed for tuberculous myelitis. According to different symptoms, there are different dietary requirements. It is recommended to consult a doctor for specific dietary standards tailored to specific diseases.

　　After an explicit diagnosis of tuberculous myelitis, regular anti-tuberculosis treatment should be initiated immediately. The drug treatment plan is as follows:
　　1. Combined use of isoniazid (INH), streptomycin, and rifampicin.
　　2. Consolidation therapy with combined use of isoniazid (INH), streptomycin, and para-aminosalicylic acid (PAS).