摘要
目的分析脑曼氏裂头蚴病的临床表现、影像特点和病理改变规律。方法回顾性分析2000年1月至2014年1月间江西省寄生虫病防治研究所临床部和南昌大学第一附属医院神经科住院治疗的42例脑部曼氏裂头蚴患者的临床资料、头颅CT和动态MRI改变，以及其中24例的脑病理改变特点。42例患者随访4—96个月。结果男性30例，女性12例，临床表现主要包括癫痫发作34例，头痛16例，轻瘫14例。头颅CT扫描有18例出现细小针尖样、点状钙化灶。增强MRI显示38例患者病灶呈聚集的多发小环状强化，14例患者病灶呈隧道样强化，13例患者存在新旧病灶迁移。24例患者进行手术，脑组织病理显示多发炎性隧道结构，20例隧道内发现了虫体，其余4例仅观察到嗜酸性粒细胞增多的隧道。18例未手术患者的脑脊液和血清学抗体均为阳性，予吡喹酮治疗后，全部患者预后良好，复查影像学结果示强化病灶消失。结论鄱阳湖水系流域是脑裂头蚴病发病相对较高的地区，其临床症状主要表现为癫痫、隐袭性头痛、轻瘫。头颅MRI增强显示病灶呈“绳结征”或者“隧道征”，与裂头蚴虫在脑组织内的迁移运动轨迹相关。除了经典的手术去除病灶治疗，大剂量长程规律口服吡喹酮药物治疗也可以取得较好的预后。
Objective To investigate the clinical features, the radiological characteristics, and the pathological changes of cerebral sparganosis. Methods We retrospectively collectted and summarized the clinical data of 42 patients with cerebral sparganosis from the Iinstitute of Anti-parasitic Diseases of Jiangxi Province and the First Affiliated Hospital of Nanchang University during January 2000 to January 2014. The follow-up period of the 42 patients ranged from 4 to 96 months. Results Forty-two cases （30 males and 12 females） with cerebral sparganosis were enrolled in the study. Among the 42 patients,34 cases suffered from seizures, 16 cases experienced headaches, and 14 cases had limb weakness. The brain CT scan showed the small and punctuate calcifications scattering around the lesions in 18 cases. The features of enhanced MRI included aggregating ring-like enhancement in 38 cases, tunnel lesions in 14 cases, and lesion migration in 13 cases. Twenty-four of the 42 patients were performed surgery. The brain tissues revealed multiple inflammatory tunnels,in which live or degenerated larvae were identified in 20 cases, but only eosinophilia tunnels were observed in the other 4 cases. The serum and cerebro-spiral fluid specimens from 18 patients without surgery were positive to spirometra mansoni antigen. Their cerebral lesions disappeared and got a favorable prognosis after administration of praziquantel in long term follow-ups. Conclusions There is a high incidence of cerebral sparganosis in Poyang lake basin. The clinical features of cerebral sparganosis mainly include seizure ,headache and hemiparesis. The enhanced lesions show ＂knot＂ or ＂tunnel＂ signs on multi-planar MRI which are associated with the multiple inflammatory tunnels of larvae migration. A longterm administration of high dose opraziquantel can also get a good treatment prognosis without the classical surgical therapy for cerebral sparganosis.
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2015年第2期108-113,共6页
Chinese Journal of Neurology
