肥厚性硬膜炎的临床与影像学特点分析

发布时间：2018-06-29 23:54

本文选题：肥厚性硬膜炎 + 临床特点　；参考：《中风与神经疾病杂志》2017年01期

【摘要】：目的总结分析肥厚性硬膜炎的临床特点及影像学特征。方法回顾性分析2005年11月~2012年8月来收治的肥厚性硬膜炎10例临床资料。结果 10例患者中7例为HCP(hypertrophic cranial pachymeningtitis,肥厚性硬脑膜炎),1例为HSP(hypertrophic spinal pachymeningtitis,肥厚性硬脊膜炎),2例为HP(hypertrophic pachymeningitis,肥厚性硬膜炎)。男性7例、女性3例,年龄40~78岁,均为慢性起病,1例伴有系统性血管炎,1例患者20 y前曾行额窦骨瘤清除术,2例伴有双侧乳突、中耳炎,1例伴双侧乳突炎及上颌窦炎。7例HCP与2例HP患者均有头痛,其中2例伴有发热、1例患者出现抽搐、7例伴有脑神经受累、1例患者有共济失调;该例HSP患者症状为双下肢麻木无力,二便急,性功能下降。对9例患者行腰穿检查,其中蛋白增高者6例,细胞数增高者4例。对7例HCP与2例HP患者行颅脑与颈髓MRI平扫+增强检查,均见硬脑膜强化,小脑幕、大脑镰、颅底、颞部、鞍上池、小脑蚓等部位均可受累,其中以大脑镰、小脑幕强化最为明显,2例并存颈椎管内硬脊膜增厚强化,1例HSP行腰椎增强MRI,可见L5-S1硬脊膜增厚强化。对7例HCP与2例HP患者给予激素治疗1 w后头痛与脑神经麻痹症状明显好转,1例HSP患者接受激素治疗后脊髓受压症状及尿便障碍稍有好转。结论 HCP与HP患者主要表现为头痛及脑神经麻痹,HSP患者主要表现为神经根痛及脊髓受压症状。头部及脊髓MRI检查具有特征性,激素治疗临床效果满意。
[Abstract]:Objective to summarize and analyze the clinical and imaging features of hypertrophic meningitis. Methods the clinical data of 10 cases of hypertrophic peritonitis from November 2005 to August 2012 were retrospectively analyzed. Results among the 10 cases, 7 cases were HCP (hypertrophic cranial pachymeningtitis, hypertrophic meningitis) 1 case was HSP( hypertrophic spinal pachymeningtitis, hypertrophic meningitis) 2 cases were HP (hypertrophic pachymeningitis, hypertrophic meningitis). There were 7 males and 3 females aged 4078 years. All of them were chronic vasculitis. One patient with systemic vasculitis had undergone frontal sinus osteoma removal before 20 years. 2 patients had bilateral mastoid processes. In 1 case of otitis media with bilateral mastositis and maxillary sinusitis, 7 cases of HCP and 2 cases of HP had headache. Among them, 2 cases were accompanied with fever and 1 case had convulsion, 7 cases with cerebral nerve involvement and 1 case with ataxia. The symptoms of HSP were numbness and weakness of lower limbs, acute stool and decreased sexual function. Lumbar puncture was performed in 9 patients, including 6 cases with increased protein and 4 cases with increased cell count. The craniocerebral and cervical spinal cord of 7 patients with HCP and 2 patients with HP were examined by plain MRI. All of them were involved in dura mater enhancement, tentorium cerebelli, falx cerebri, skull base, temporal part, suprasellar cistern, cerebellar vermis, and so on. The most obvious enhancement of cerebellar tentorium was seen in 2 cases with cervical spinal dural thickening and 1 case of HSP underwent lumbar enhancement MRI.The enhancement of L5-S1 dural thickening was observed in 1 case. 7 cases of HCP and 2 cases of HP were treated with hormone for 1 week. The symptoms of headache and cerebral nerve palsy were obviously improved. One case of HSP received hormone therapy, and the symptoms of spinal cord compression and urinary defecation were slightly improved. Conclusion the main symptoms of HCP and HP are headache and cerebral palsy with HSP. The main symptoms of HCP and HP are neuralgia and spinal cord compression. MRI examination of head and spinal cord is characteristic and the clinical effect of hormone therapy is satisfactory.
【作者单位】：郑州大学第五附属医院神经内科;
【基金】：国家自然基金资助项目(No.81301006)
【分类号】：R741

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