请简述各种颅内感染的脑脊液特点。
答案:
细菌性:脑脊液压力显著升高,性状白色浑浊,白细胞数成千上万,中性核细胞为主,糖含量低,蛋白质含量高,革兰染色培养(+)
病毒性:脑脊液压力不高或略高,性状无色透明,白细胞数正常或略高,淋巴细胞为主,糖含量正常,蛋白质含量正常或略高,病毒PCR(+)
结核性:脑脊液压力显著升高,性状为淡黄,白细胞数数十到数百,淋巴细胞为主,糖含量低,蛋白质含量显著高,抗酸染色(+)
隐球菌性:脑脊液压力显著升高,形状为无色透明,白细胞数数十到数百,淋巴细胞为主,糖含量显著低,蛋白质含量中等高,墨汁染色(+)
化脓性脑炎 结核性脑炎 病毒性脑炎
压力 高 常升高, 阻力低 正常或升高
外观 浑浊(米汤样) 毛玻璃样 清亮
潘氏试验 阳性 阳性 阴性
白细胞数×106/L 常大于1000 常小于1000 可正常,也可与结脑相当,淋巴细胞为主
蛋白质(g/L) 1~5,偶尔大于10 增高,阻塞时显著增高 正常或稍高(小于1)
葡萄糖 明显减低 减低 正常
其他 涂片、培养可发现细菌 涂片可发现抗酸杆菌,培养结核杆菌阳性 病毒抗体阳性,病毒培养时阳性
Bacterial: cerebrospinal fluid pressure increased significantly, white and turbid, thousands of leukocytes, mainly neutrophils, low sugar content, high protein content, Gram staining culture (+)
Viral: cerebrospinal fluid pressure is not high or slightly high, the character is colorless and transparent, the number of leukocytes is normal or slightly high, mainly lymphocytes, sugar content is normal, protein content is normal or slightly high, viral PCR (+)
Tuberculous: the cerebrospinal fluid pressure is significantly increased, the character is light yellow, the number of leukocytes is dozens to hundreds, mainly lymphocytes, low sugar content, significantly high protein content, acid fast staining (+)
Cryptococcal: the cerebrospinal fluid pressure is significantly increased, the shape is colorless and transparent, the number of leukocytes is dozens to hundreds, mainly lymphocytes, the sugar content is significantly low, the protein content is medium and high, and the ink staining (+)