脑脊液E-B病毒阳性的肥厚性硬脑膜炎一例报告并文献复习

发布时间：2018-03-30 14:08

本文选题：肥厚性硬脑膜炎　切入点：E-B病毒　出处：《山东大学》2014年硕士论文

【摘要】：目的结合国内外相关文献探讨肥厚性硬脑膜炎的流行病学特点、病因及分类、临床表现、实验室检查特点、影像学特点、病理学特点、诊断及鉴别诊断、治疗与预后等。肥厚性硬脑膜炎为临床罕见病、少见病,本文的目的为提高临床医生对此病的认识,系统了解本病相关特点,减少误诊率及漏诊率,改善临床治疗效果。方法报告本院收治的1例肥厚性硬脑膜炎患者的临床资料,回顾性分析本患者的发病过程、临床表现、影像特点、治疗经过、疾病转归的相关情况。并系统复习国内外相关文献,对肥厚性硬脑膜炎的流行病学特点、病因及分类、临床表现、实验室检查特点、影像学特点、病理学特点、诊断及鉴别诊断、治疗与预后等方面进行系统讨论。结果本例患者因“无明显诱因阵发性头痛6年,复视1月”入院。患者于6年前始无明显诱因出现间断性头痛,间隔时间由数月至数年不等,每次发作呈持续性胀痛,以后枕部、顶部为重,期间有数次“癫痫大发作”。患者于1月前再次无明显诱因出现头痛、复视、吞咽不畅,此次发病无癫痫发作。查体左眼视力较右眼弱(右眼1.0,左眼0.6)；左侧、正前方向视物复视,右侧方向视物无复视,左眼球外展运动稍受限；右侧眼裂以下面部皮肤感觉稍迟钝；咽反射迟钝。实验室检查结果：血沉：33mm/h(2-20),脑脊液白细胞计数27x106/L(0-8),潘氏实验(+),脑脊液蛋白0.74g/L(0.00-0.40),脑脊液病毒-DNA:3140IU/ml(50为阳性),C反应蛋白12.60mg/L(0.00-7.00)。颅脑CT显示小脑幕区及后纵裂高信号,脑磁共振示局部硬脑膜异常增生并强化,营养神经药物治疗后病情得以控制。结论肥厚性硬脑膜炎为临床少见病,国内外文献多以个案报道为主,临床表现多样,缺乏特异性症状,易漏诊、误诊。此病男性多见,好发年龄为40-60岁。按其病因分：特发性HCP(idiopathic HCP, IHCP)和继发性HCP(secondary HCP, SHCP)。首发症状常为头痛,其他表现有脑神经受损症状、共济失调、颅内动脉闭塞、静脉窦血栓、脑积水、癫痫、精神症状等。实验室检查白细胞计数及百分比增加、血沉(ESR)轻度增快、髓过氧化物嗜中性粒细胞胞浆抗体(MPO-ANCA)阳性、类风湿因子(RF)阳性、C反应蛋白(CRP)轻度增高较为常见。CT平扫可表现出高密度的增生肥厚的硬脑膜,MRI平扫可见弥漫性增厚的硬脑膜,增厚的硬脑膜在T1WI呈等或低信号,在T2WI呈低信号,其周边可见高信号影。病理学检查可见硬脑膜呈明显的纤维性增生,并可见玻璃样变性,还可见中性粒细胞、淋巴细胞、浆细胞等大量炎性细胞浸润。此外还可见由多核巨细胞、纤维母细胞、上皮细胞构成的肉芽肿。病理学检查还可能发现相关细菌、病毒、真菌等代谢活动中产生的特异性物质及特异性结构。部分患者病情可呈发病-缓解-发病-再缓解的规律,但总体病情常呈加重趋势,大部分病例经药物或手术治疗后可病情缓解,且随访显示常可维持较长时间,但仍有部分病例临床干预无效,病情在短时间进行性加重,甚至死亡。
[Abstract]:Objective To study the epidemiological characteristics , etiology , classification , pathological characteristics , diagnosis and differential diagnosis , pathology , diagnosis and differential diagnosis , treatment and prognosis of hypertrophic hard meningitis . The aim of this paper is to improve the clinical doctors ' understanding of the disease , to understand the relevant characteristics of the disease , to reduce the misdiagnosis rate and the missed diagnosis rate , and to improve the clinical treatment effect .

Methods The clinical data of 1 patient with hypertrophic and hard meningitis treated in our hospital were analyzed retrospectively . The incidence , clinical manifestation , image characteristics , treatment and prognosis of the patients were analyzed retrospectively . The epidemiological characteristics , etiology , classification , clinical manifestation , laboratory examination characteristics , imaging characteristics , pathological characteristics , diagnosis and differential diagnosis , treatment and prognosis of hypertrophic hard meningitis were reviewed .

Results In this case , the patient was admitted to the hospital for 6 years without obvious induced paroxysmal headache . The patient had no obvious cause of intermittent headache at the beginning of 6 years . The interval was prolonged from several months to several years .
The left , right front , and right direction were diplopia , and the left eyeball abduction movement was slightly limited .
The following facial skin feels slightly obtuse under the right eye ;
The results of laboratory examination were : ESR : 33mm / h ( 2 - 20 ) , white blood cell count 27x106 / L ( 0 - 8 ) , Pan ' s experiment ( + ) , cerebrospinal fluid protein 0.74g / L ( 0.00 - 0.40 ) , cerebrospinal fluid virus - DNA : 3140IU / ml ( 50 % positive ) , C - reactive protein 12.60 mg / L ( 0.00 - 7.00 ) . Brain CT showed small brain curtain region and posterior longitudinal fissure high signal , and brain magnetic resonance showed abnormal hyperplasia of dura mater and strengthened .

Conclusion Hypertrophic hard meningitis is rare in clinic . There are many cases reported in domestic and foreign literatures . The clinical manifestations are diverse , lack of specific symptoms , easy leakage diagnosis and misdiagnosis . For men with this disease , the age is 40 - 60 years old . According to the etiology , idiopathic HCP , IHCP and secondary HCP ( SHCP ) are classified . The results showed that there was a significant increase in the number and percentage of white blood cells ( ESR ) , mild increase of ESR , and mild increase of C - reactive protein ( CRP ) .

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.3

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