本文报告1例以头痛和视物模糊起病的青年女性，影像学显示颅内多发环形强化小结 节，呈满天星样分布。患者3周前有药物流产史，实验室检查提示红细胞沉降率及超敏C反 应蛋白显著升高，血清T淋巴细胞斑点试验（T-cell spot test，T-SPOT）强阳性，胸部CT示双 肺粟粒性结节。结合实验室检查结果及影像特征，最终诊断为粟粒性脑结核合并肺结核。 经抗结核治疗后症状显著改善。本文回顾并探讨了颅内多发环形强化病变（满天星征）的 鉴别诊断思路。

This case reports a young woman presenting with headache and blurred vision, with imaging revealing multiple ring-enhancing micronodules diffusely distributed throughout the brain, exhibiting a starry sky pattern. The patient had a history of medication abortion 3 weeks prior. Laboratory tests showed significantly elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), strongly positive serum T-cell spot test (T-SPOT), and chest CT demonstrating miliary nodules in both lungs. Integrated with the laboratory findings and imaging features, the patient was ultimately diagnosed with miliary cerebral tuberculosis complicated by pulmonary tuberculosis. Symptoms markedly improved after antitubercular therapy. This article reviews and discusses the differential diagnostic approach to intracranial multiple ring-enhancing lesions (starry sky sign).