静脉溶栓治疗结核性脑膜炎并发青年缺血性卒中一例

Intravenous Thrombolysis for Tuberculous Meningitis Complicated with Ischemic Stroke in a Young Patient

摘要: 青年卒中病因多样，以心源性多见，而结核性脑膜炎所致的脑梗死并静脉溶栓的少见。患者青年男性，结核性脑膜炎规范抗结核治疗期间发生急性缺血性脑卒中(Acute ischemic stroke, AIS)，于3 h时间窗内予静脉溶栓，桥接DSA未发现大血管闭塞，静脉溶栓结束后疗效佳，次日病情再发加重，行头部磁共振提示为急性期脑梗死，发病90天电话随访病情明显好转。结核性脑膜炎并发青年缺血性卒中静脉溶栓可能有效，建议当怀疑有结核性脑膜炎时，应立即开始使用抗结核 + 皮质类固醇 + 阿司匹林治疗，但目前仍存在争议。

Abstract: The causes of stroke in young population are various, most of which are cardiogenic, while cerebral infarction caused by tuberculous meningitis and intravenous thrombolysis is rare. A young male patient with tuberculous meningitis developed acute ischemic stroke (Acute ischemic stroke, AIS) during standard anti-tuberculous treatment. Intravenous thrombolysis was performed within the time window of 3 h. No large vessel occlusion was found by bridging DSA after thrombolysis. The curative effect was good. However, the disease was aggravated next day. The head MRI showed acute cerebral infarction. The patient’s condition improved significantly after 90-day’s telephone follow-up. Intravenous thrombolysis may be effective in the treatment of tuberculous meningitis complicated with ischemic stroke in young population. It is recommended that anti-tuberculous plus corticosteroid and aspirin should be used immediately when tuberculous meningitis is sus-pected, but there is still controversy.