蛛网膜型脑囊虫病病例分析并文献复习

发布时间：2018-04-26 10:25

本文选题：蛛网膜型脑囊虫病 + 临床特点　；参考：《广西医科大学》2014年硕士论文

【摘要】：目的：探讨蛛网膜型脑囊虫的临床特点、诊断及治疗策略,提高临床医师对其的认识。方法：回顾性分析2003-2013年在广西医科大学一附院诊断的7例蛛网膜型脑囊虫病病例的临床资料,并结合计算机检索得到的国内外文献进行讨论。结果：7例均为男性,年龄45岁(32岁,63岁),病程为3年(2周,10年)。4例流行病史阳性。6例出现颅高压表现,3例出现视力改变,2例出现运动系统受累。2例出现癫痫发作,1例出现高级神经活动障碍。7例均无脑膜刺激征阳性。血清学：7/7囊虫酶标均阳性,3/7嗜酸性粒细胞增高。大便学：1/7虫卵阳性。脑脊液检查：颅内压改变(4/7例增高,3/7例降低)。3/7例出现葡萄糖、氯化物有改变。蛋白异常(6/7定性异常,3/7定量异常)。3/7例脑脊液细胞数增高。4/4腺苷脱氢酶正常范围。7/7病例脑脊液囊虫酶标阳性。7例头颅MRI检查异常,3/6例MRI增强出现病灶强化。1例术中病理。结论：1、蛛网膜型脑囊虫病是一种少见中枢神经系统寄生虫感染性疾病之一。2、蛛网膜型脑囊虫临床特点与包囊部位、数目及大小有关,高颅压征表现多见,容易合并有颅神经损害及“卒中”类似现象。其临床特点多变,免疫学、影像学、病理活检以及流行病学有助于诊断。3、蛛网膜型脑囊虫病对药物治疗不敏感,联合外科手术治疗能一定程度上改善预后,尤其内镜下去除包囊术联合药物治疗效果好,可作为优选治疗方案之一。
[Abstract]:Objective: to explore the clinical features, diagnosis and treatment strategies of arachnoid cerebral cysticercosis and to improve the understanding of arachnoid cysticercosis. Methods: the clinical data of 7 cases of arachnoid type cerebral cysticercosis diagnosed in the first affiliated Hospital of Guangxi Medical University from 2003 to 2013 were analyzed retrospectively. Results all 7 cases were male. The age was 45 years old, 32 years old and 63 years old, the course of disease was 3 years and 2 weeks. In 10 years of epidemic history, there were 6 cases with intracranial hypertension and 3 cases with visual acuity. 2 cases had motor system involvement. 2 cases had epileptic seizure. 1 case had advanced nerve activity. There was no positive meningeal stimulation sign in 7 cases of dyskinesia. Serology 7 / 7 cysticercosis was positive for 3 / 7 eosinophils. Stool is positive for 1 / 7 of the eggs. Cerebrospinal fluid examination: intracranial pressure change 4 / 7 cases increased 3 / 7 cases decreased 3 / 7 cases showed glucose and chloride changed. Protein abnormality 6 / 7 qualitative abnormality 3 / 7 quantitative abnormality. The number of cerebrospinal fluid cells increased. 4 / 4 adenosine dehydrogenase normal range. 7 / 7 cases of cerebrospinal fluid Cysticercosis enzyme positive 7 cases head MRI abnormal 3 / 7 / 6 cases of MRI enhancement. 1 cases of intraoperative pathological changes were found in the patients with cerebrospinal fluid (CSF) cell number increased or 4 / 4 adenosine dehydrogenase (ADH) normal range. ConclusionThe arachnoid type cerebral cysticercosis is one of the rare parasitic infectious diseases of the central nervous system. The clinical characteristics of arachnoid cerebral cysticercosis are related to the location, number and size of the cyst, and the high intracranial pressure sign is more common. It is easy to be associated with cranial nerve damage and stroke. Its clinical characteristics are variable, immunology, imaging, pathological biopsy and epidemiology are helpful for diagnosis. Arachnoid type cerebral cysticercosis is insensitive to drug therapy, and combined surgical treatment can improve prognosis to some extent. In particular, endoscopic cysts removal combined with drug therapy is effective, and can be used as one of the optimal treatment options.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R532.33

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