The clinical manifestations of tuberculous meningoencephalitis(TBME)are varied,and diagnostic tests for Mycobacterium tuberculosis show limited sensitivity and specificity,often failing to provide timely diagnostic support,which can delay prompt treatment.Reports on anti-neurexin-3α antibody-mediated autoimmune encephalitis remain scarce,and there have been no documented cases of TBME overlapping with anti-neurexin-3α antibody-associated encephalitis either domestically or internationally.This article presents a case treated at our hospital to contribute insights for improving the diagnosis and treatment of such conditions in the future.The patient,a middle-aged woman,presented with a one-month history of headache and incoherent speech,along with one day of left-sided limb weakness.Lumbar puncture results revealed significantly elevated cerebrospinal fluid(CSF)pressure,an increased lymphocyte count,and reduced glucose and chloride levels.Enhanced MRI showed multiple intracranial lesions,basal meningeal enhancement,and marked hydrocephalus,supporting an initial diagnosis of TBME.Concurrently,both blood and CSF tests were positive for anti-neurexin-3α antibodies.After comprehensive treatment,including anti-tuberculosis therapy,high-dose immunoglobulin,and corticosteroids,the patient's clinical symptoms,CSF findings,and MRI results improved,and she was discharged.

The clinical manifestations of tuberculous meningoencephalitis(TBME)are varied,and diagnostic tests for Mycobacterium tuberculosis show limited sensitivity and specificity,often failing to provide timely diagnostic support,which can delay prompt treatment.Reports on anti-neurexin-3α antibody-mediated autoimmune encephalitis remain scarce,and there have been no documented cases of TBME overlapping with anti-neurexin-3α antibody-associated encephalitis either domestically or internationally.This article presents a case treated at our hospital to contribute insights for improving the diagnosis and treatment of such conditions in the future.The patient,a middle-aged woman,presented with a one-month history of headache and incoherent speech,along with one day of left-sided limb weakness.Lumbar puncture results revealed significantly elevated cerebrospinal fluid(CSF)pressure,an increased lymphocyte count,and reduced glucose and chloride levels.Enhanced MRI showed multiple intracranial lesions,basal meningeal enhancement,and marked hydrocephalus,supporting an initial diagnosis of TBME.Concurrently,both blood and CSF tests were positive for anti-neurexin-3α antibodies.After comprehensive treatment,including anti-tuberculosis therapy,high-dose immunoglobulin,and corticosteroids,the patient's clinical symptoms,CSF findings,and MRI results improved,and she was discharged.

Objective To investigate the distribution and antimicrobial resistance of pathogens causing pneumonia in acute stroke patients,and guide clinical antimicrobial use.Methods Patients with stroke-associated pneumonia (SAP)admitted to a tertiary first-class hospital from 2008 to 2013 were investigated retrospectively,distribution and antimicrobial susceptibility testing results of pathogens from sputum were analyzed.Results A total of 98 pa-tients with SAP were investigated,124 stains were isolated from sputum specimens,75 strains (60.48% )were gram-negative bacteria,44 (35.49% )were gram-positive bacteria,and 5 (4.03% )were fungi. There were 21 cases of mixed infection (21.43% ),bacterial alterations during treatment process existed among 23 cases(23.47% ).The top 4 isolated pathogens were Staphylococcus aureus (S. aureus,n= 43,34.68% ),Klebsiella pneumoniae (K. pneumoniae,n= 19,15.32% ),Pseudomonasaeruginosa(P. aeruginosa,n= 18,14.52% ),and Acinetobacterbau-mannii(A. baumannii,n= 18,14.52% ). Antimicrobial resistance rates of K. pneumoniae were all <32% ,and susceptibility rates to ceftazidime,piperacillin/tazobactam,imipenem,ciprofloxacin,levofloxacin,amikacin,and tobramycin were all 100% . Both A.baumannii and P.aeruginosa showed severe multidrug resistance. Resistance rates of A.baumannii to ceftazidime was >80% ,resistance rates of P.aeruginosa to imipenem was 33 .33% . No resistant strains were detected among fungi.Conclusion The main pathogens causing SAP in this hospital are S.au-reus,K.pneumoniae,A.baumannii,and P.aeruginosa,except K.pneumoniae,the other strains are severely re-sistant to antimicrobial agents,clinicians should choose antimicrobial agents according to the distribution character-istics and antimicrobial susceptibility testing results.