36例成人流行性乙型脑炎临床分析和影像学特点

doi:10.6040/j.issn.1671-7554.0.2017.1013

摘要/Abstract

摘要： 目的总结和分析成人乙脑的临床表现、脑脊液及颅脑影像学特点。方法对山东大学齐鲁医院神经内科2013年8月到2013年9月间收治的36例成人乙脑患者进行回顾性分析。结果乙脑患者主要表现为高热(100%)、意识及认知障碍、头痛、恶心、呕吐(86.1%)、脑膜刺激征(80.6%),帕金森样症状(30.6%)和癫痫(27.8%)也较常见。血清和脑脊液乙脑IgM抗体阳性。颅压增高13例(54.2%),22例脑脊液细胞学检测出现异常细胞反应,16例(72.7%)混合细胞反应,6例(27.3%)淋巴细胞反应。17例(70.8%)蛋白升高,21例(87.5%)IgG、19例(79.2%)IgA、23例(95.8%)IgM升高。22例(61.1%)行颅脑MRI,17例(47.2%)行颅脑CT。累及丘脑13例(59.1%),累及中脑4例(18.2%)、基底节3例(13.6%)、海马3例(13.6%)和其他脑叶5例(22.7%),4例(18.2%)未见异常。结论流行性乙型脑炎的临床表现为急性脑炎综合征,可合并锥体外系症状;脑脊液中性粒细胞比例明显增加,混合细胞反应持续时间长;丘脑损害是最常见的影像学改变。

关键词: 流行性乙型脑炎, 临床特征, 脑脊液, 颅脑MRI, 成人

Abstract: Objective To investigate clinical, cerebrospinal fluid(CSF)and radiological features of adult patients with epidemic encephalitis B. Methods The data were collected from 36 adult patients with epidemic encephalitis B who were diagnosed and treated in Qilu Hospital of Shandong University, from August to September in 2013. Results The patients with epidemic encephalitis B presented with fever(100%), consciousness and cognitive impairment, headache, nausea, vomiting(86.1%), and meningeal irritation(80.6%). Parkinson-like symptoms(30.6%)and seizure disorders(27.8%)were common. The IgM antibody against epidemic encephalitis B in serum and CSF was found. A total of 13 patients(54.2%)suffered intracranial hypertension, 22 patients displayed abnormal CSF cytology reaction, 16 patients(72.7%)displayed mixed-cell reaction, 6 patients(27.3%)appeared lymphocyte reaction. Protein content of 17 patients(70.8%)increased, IgG of 21 patients(87.5%)increased, IgA of 19 patients(79.2%)increased, and IgM of 23 patients(95.8%)increased. A total of 22 patients(61.1%)underwent brain MRI, 17 patients(47.2%)underwent brain CT. Neural damages displayed in thalamus(13 cases, 59.1%), midbrain(4 cases, 18.2%), basal ganglia(3 cases, 13.6%), hippocampus(3 cases, 13.6%)and other brain lobes(5 cases, 22.7%). A total of 4 patients(18.2%)were normal. Conclusion The patients with epidemic encephalitis B present acute encephalitic syndrome, 山东大学学报 (医学版)56卷2期 -苗萌,等.36例成人流行性乙型脑炎临床分析和影像学特点 \=-accompanied with extrapyramid symptoms. The important features of CSF present the significant increase of the proportion of neutrophils and the prolonged duration of mixed-cell reaction. Neural damages commonly appear in thalamus.

Key words: Epidemic encephalitis B, Clinical features, Cerebrospinal fluid, Brain MRI, Adults

中图分类号:

R512.32

苗萌,贾国勇,刘颖,王翠兰. 36例成人流行性乙型脑炎临床分析和影像学特点[J]. 山东大学学报 (医学版), 2018, 56(2): 23-27.

MIAO Meng, JIA Guoyong, LIU Ying, WANG Cuilan. Clinical and radiological features of 36 adult patients with epidemic encephalitis B[J]. Journal of Shandong University (Health Sciences), 2018, 56(2): 23-27.

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