本文選題：神經(jīng)結(jié)節(jié)病 + 腦脊液��； 參考：《中國神經(jīng)精神疾病雜志》2016年10期

【摘要】：目的伴腦脊液(cerebrospinal fluid,CSF)糖低下的神經(jīng)結(jié)節(jié)病十分罕見且容易誤診。本文探討伴CSF糖水平低下的神經(jīng)結(jié)節(jié)病臨床特點(diǎn)及總結(jié)診治經(jīng)驗(yàn)。方法總結(jié)我院收治的1例伴CSF糖水平低下的神經(jīng)結(jié)節(jié)病臨床特點(diǎn)及診治經(jīng)過,并系統(tǒng)性回顧既往國內(nèi)外報(bào)道的類似病例臨床特征及診治情況。結(jié)果本例患者CSF糖顯著降低,頭顱和脊髓MRI提示腦脊膜增厚、強(qiáng)化及多發(fā)肉芽腫性病變。腦活檢病理顯示非干酪樣肉芽腫改變。回顧性分析提示:7例患者中5例頭顱MRI多有廣泛腦膜炎癥。4例患者在病程早期誤診為結(jié)核,3例則無法明確區(qū)分結(jié)節(jié)病、結(jié)核或淋巴瘤樣肉芽腫。最終確診多依賴胸部CT、67鎵掃描/18F-FDG PET、頭顱MRI等發(fā)現(xiàn)可疑病灶進(jìn)一步取活檢。結(jié)論伴發(fā)CSF低糖的神經(jīng)結(jié)節(jié)病多出現(xiàn)廣泛腦膜病變,易誤診為結(jié)核性腦膜腦炎。詳細(xì)尋找包括中樞神經(jīng)系統(tǒng)(central nervous system,CNS)以外組織的可疑病灶十分重要,確診依賴病理結(jié)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.
【作者單位】： 中山大學(xué)附屬第三醫(yī)院;
【基金】：國家自然科學(xué)基金(編號:81100886,81301028) 廣東省自然科學(xué)基金(編號:81171126)
【分類號】：R741

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