本文選題：蛛網(wǎng)膜型腦囊蟲(chóng)病 + 臨床特點(diǎn)　； 參考：《廣西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：探討蛛網(wǎng)膜型腦囊蟲(chóng)的臨床特點(diǎn)、診斷及治療策略,提高臨床醫(yī)師對(duì)其的認(rèn)識(shí)。 方法：回顧性分析2003-2013年在廣西醫(yī)科大學(xué)一附院診斷的7例蛛網(wǎng)膜型腦囊蟲(chóng)病病例的臨床資料,并結(jié)合計(jì)算機(jī)檢索得到的國(guó)內(nèi)外文獻(xiàn)進(jìn)行討論。 結(jié)果：7例均為男性,年齡45歲(32歲,63歲),病程為3年(2周,10年)。4例流行病史陽(yáng)性。6例出現(xiàn)顱高壓表現(xiàn),3例出現(xiàn)視力改變,2例出現(xiàn)運(yùn)動(dòng)系統(tǒng)受累。2例出現(xiàn)癲癇發(fā)作,1例出現(xiàn)高級(jí)神經(jīng)活動(dòng)障礙。7例均無(wú)腦膜刺激征陽(yáng)性。血清學(xué)：7/7囊蟲(chóng)酶標(biāo)均陽(yáng)性,3/7嗜酸性粒細(xì)胞增高。大便學(xué)：1/7蟲(chóng)卵陽(yáng)性。腦脊液檢查：顱內(nèi)壓改變(4/7例增高,3/7例降低)。3/7例出現(xiàn)葡萄糖、氯化物有改變。蛋白異常(6/7定性異常,3/7定量異常)。3/7例腦脊液細(xì)胞數(shù)增高。4/4腺苷脫氫酶正常范圍。7/7病例腦脊液囊蟲(chóng)酶標(biāo)陽(yáng)性。7例頭顱MRI檢查異常,3/6例MRI增強(qiáng)出現(xiàn)病灶強(qiáng)化。1例術(shù)中病理。 結(jié)論：1、蛛網(wǎng)膜型腦囊蟲(chóng)病是一種少見(jiàn)中樞神經(jīng)系統(tǒng)寄生蟲(chóng)感染性疾病之一。2、蛛網(wǎng)膜型腦囊蟲(chóng)臨床特點(diǎn)與包囊部位、數(shù)目及大小有關(guān),高顱壓征表現(xiàn)多見(jiàn),容易合并有顱神經(jīng)損害及“卒中”類(lèi)似現(xiàn)象。其臨床特點(diǎn)多變,免疫學(xué)、影像學(xué)、病理活檢以及流行病學(xué)有助于診斷。3、蛛網(wǎng)膜型腦囊蟲(chóng)病對(duì)藥物治療不敏感,聯(lián)合外科手術(shù)治療能一定程度上改善預(yù)后,尤其內(nèi)鏡下去除包囊術(shù)聯(lián)合藥物治療效果好,可作為優(yōu)選治療方案之一。
[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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R532.33

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