伴脑脊液糖水平低下的神经结节病:临床特点及误诊分析

发布时间：2018-07-12 15:56

本文选题：神经结节病 + 脑脊液　；参考：《中国神经精神疾病杂志》2016年10期

【摘要】：目的伴脑脊液(cerebrospinal fluid,CSF)糖低下的神经结节病十分罕见且容易误诊。本文探讨伴CSF糖水平低下的神经结节病临床特点及总结诊治经验。方法总结我院收治的1例伴CSF糖水平低下的神经结节病临床特点及诊治经过,并系统性回顾既往国内外报道的类似病例临床特征及诊治情况。结果本例患者CSF糖显著降低,头颅和脊髓MRI提示脑脊膜增厚、强化及多发肉芽肿性病变。脑活检病理显示非干酪样肉芽肿改变。回顾性分析提示:7例患者中5例头颅MRI多有广泛脑膜炎症。4例患者在病程早期误诊为结核,3例则无法明确区分结节病、结核或淋巴瘤样肉芽肿。最终确诊多依赖胸部CT、67镓扫描/18F-FDG PET、头颅MRI等发现可疑病灶进一步取活检。结论伴发CSF低糖的神经结节病多出现广泛脑膜病变,易误诊为结核性脑膜脑炎。详细寻找包括中枢神经系统(central nervous system,CNS)以外组织的可疑病灶十分重要,确诊依赖病理结果。
[Abstract]:Objective Neurosarcoidosis with cerebrospinal fluid hypoglycemia is rare and easy to misdiagnose. To investigate the clinical features of neurosarcoidosis with hypoglycemia of CSF and to summarize the experience of diagnosis and treatment. Methods A case of neurosarcoidosis with hypoglycemia of CSF was treated in our hospital. The clinical features and diagnosis and treatment of similar cases were reviewed systematically. Results CSF glucose was significantly decreased in this case. MRI of the head and spinal cord showed thickening, enhancement and multiple granulomatous lesions of the cerebral meninges. Pathology of brain biopsy showed the change of non-caseous granuloma. Retrospective analysis showed that 5 of 7 cases had extensive meningitis in 5 cases. 4 cases were misdiagnosed as tuberculosis in the early stage of the disease. 3 cases could not distinguish sarcoidosis, tuberculosis or lymphoma granuloma. The final diagnosis depends on chest CT 67 gallium scan / 18F-FDG PET, cranial MRI and other suspicious lesions found further biopsy. Conclusion the neurosarcoidosis with low CSF and low glucose often has extensive meningeal lesions and is easily misdiagnosed as tuberculous meningoencephalitis. It is important to look for suspicious lesions in tissues other than the central nervous system (central nervous), and the diagnosis depends on the pathological results.
【作者单位】：中山大学附属第三医院;
【基金】：国家自然科学基金(编号:81100886,81301028) 广东省自然科学基金(编号:81171126)
【分类号】：R741

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