| A Clinical Study of Tuberculous Meningitis and Diagnositc Significance of Tryptophan Test |
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Seog Won Yang, Jae Woong Park, Jeong Kun Park, Jung Kon Hong, Je Won Kim, Jong Yoon Lim |
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Department of Internal, Hangang Sacred Heart Hospital, Hallym College, Seoul, Korea |
| 결핵성뇌막염의 임상적 고찰과 Tryptophan 검사의 진단적 의의 |
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양석원, 박재웅, 박정근, 홍정곤, 김예원, 임종윤 |
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| Abstract |
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We analyzed the clinical and laboratory findings of 474 patients with tuberculous meningitis (including pediatric subjects) to evaluate the usefulness of tryptophan test and identify important factors influencing the outcome of tuberculous meningitis seen between January 1974 and August 1983 at the Hangang Sacred Heart Hospital, Hallym college.
1) The highest incidence by age was noted as 48, 3% under the age of 5 years, but highest incidence of adult were noted among second decade (15.7%) . Male to female ratio was 1. 16: 1.
2) The annual and seasonal incidences were not statistically significant, but showed a trend of decrement after 1981.
3) The tryptophan test was done on 28 cases of tuberculous meningitis on admission. Of these 28 cases, 23 cases(82. 1 % ) gave positive results.
4) The chief complaints on admission were in the order of headache, fever, vomiting, neck stiffness and mental disturbance. On neurological examination, Kernig’s sign were positive in 24.9%, Brudzinski’s sign in 17.1 %, Babinski’s sign in 13.5% and knee jerk abnormality in 27. 9%.
5) The duration from onset to admission was within 2 weeks in 77.1 % of the cases.
Stages were classified by clinical criterions at admission to 1,2, and 3. And these stages occupied by 60.1 %, 27 % and 10.9% respectively.
6) The concomittent extrameningeal tuberculosis was found in 42% of all cases and pulmonary tuberculosis was the commonest lesion(24.9 %).
7) The CSF analysis on admission revealed increased CSF pressure(75. 1 %), leulacytosis(100 %) , increased protein(89.6%) , decreased sugar(41. 4% ) and only 2% of positive AFB smear of CSF.
8) The overall mortality was 19.7% and stage 1,2, and 3 showed each mortality rate of 7.8%, 23.2% and 76.2% respectively.
9) The late sequelae was found by 32 patients among the 155 survivors, including blurred vision, hemiparesis, dysarthria and mental disturbance. |
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