本文選題：肥厚性硬膜炎 + 臨床特點　； 參考：《中風與神經(jīng)疾病雜志》2017年01期

【摘要】：目的總結分析肥厚性硬膜炎的臨床特點及影像學特征。方法回顧性分析2005年11月~2012年8月來收治的肥厚性硬膜炎10例臨床資料。結果 10例患者中7例為HCP(hypertrophic cranial pachymeningtitis,肥厚性硬腦膜炎),1例為HSP(hypertrophic spinal pachymeningtitis,肥厚性硬脊膜炎),2例為HP(hypertrophic pachymeningitis,肥厚性硬膜炎)。男性7例、女性3例,年齡40~78歲,均為慢性起病,1例伴有系統(tǒng)性血管炎,1例患者20 y前曾行額竇骨瘤清除術,2例伴有雙側乳突、中耳炎,1例伴雙側乳突炎及上頜竇炎。7例HCP與2例HP患者均有頭痛,其中2例伴有發(fā)熱、1例患者出現(xiàn)抽搐、7例伴有腦神經(jīng)受累、1例患者有共濟失調;該例HSP患者癥狀為雙下肢麻木無力,二便急,性功能下降。對9例患者行腰穿檢查,其中蛋白增高者6例,細胞數(shù)增高者4例。對7例HCP與2例HP患者行顱腦與頸髓MRI平掃+增強檢查,均見硬腦膜強化,小腦幕、大腦鐮、顱底、顳部、鞍上池、小腦蚓等部位均可受累,其中以大腦鐮、小腦幕強化最為明顯,2例并存頸椎管內硬脊膜增厚強化,1例HSP行腰椎增強MRI,可見L5-S1硬脊膜增厚強化。對7例HCP與2例HP患者給予激素治療1 w后頭痛與腦神經(jīng)麻痹癥狀明顯好轉,1例HSP患者接受激素治療后脊髓受壓癥狀及尿便障礙稍有好轉。結論 HCP與HP患者主要表現(xiàn)為頭痛及腦神經(jīng)麻痹,HSP患者主要表現(xiàn)為神經(jīng)根痛及脊髓受壓癥狀。頭部及脊髓MRI檢查具有特征性,激素治療臨床效果滿意。
[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.
【作者單位】： 鄭州大學第五附屬醫(yī)院神經(jīng)內科;
【基金】：國家自然基金資助項目(No.81301006)
【分類號】：R741

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