原发性化脓性脑室炎2例临床分析

Clinical analysis of 2 cases of primary pyogenic ventriculitis

本文报告2例原发性化脓性脑室炎。病例1为60岁女性,因精神行为异常入院,表现为自言自语、烦躁不安,伴发热,就诊期间出现痫样发作。查体发现神志浅昏迷,瞳孔对光反应灵敏,疼痛刺激四肢见活动,双侧Babinski征可疑阳性,颈抵抗,Kernig征阴性。病例2为58岁男性,以尿频、尿痛伴发热、头痛起病,经治疗后尿路刺激症状改善,发热头痛无缓解。体格检查发现锥体束受累、脑膜刺激征阳性。2例患者完善脑脊液检查提示细胞数增多,头颅磁共振成像(magnetic resonance imaging,MRI)示脑室积脓,结合病史及相关辅助检查,诊断为原发性化脓性脑室炎。经积极抗感染后,恢复良好。原发性化脓性脑室炎仅少量个案报道,易被误诊,通过分析2个病例的临床诊治过程,提高对该病诊治的认识。

This article reports two cases of primary pyogenic ventriculitis.C.ase 1 was a 60-year-old female admitted to the hospital with abnormal psychiatric behavior,presenting with self-talk and irritability with fever and epileptic seizures during the consultation.Neurological examination revealed shallow coma,pupils responsive to light,painful stimulation of the extremities saw activity,suspicious positive Babinski sign bilaterally,neck resistance,negative Kernig sign.Case 2 was a 58-year-old male with complains of urinary frequency,painful urination with fever and headache-The urinary tract irritation symptoms improved but the fever and headache remained unchanged after treatment.Physical examination revealed cone bundle involvement and positive signs of meningeal irritation.Cerebrospinal fluid examination revealed increased cell count and cranial magnetic resonance imaging showed pus accumulation in the ventricles.Based on combined with medical history and laboratorys findings,Two patients were diagnosed with primary pyogenic ventriculitis.They recovered well following intensive anti-infection therapy.Primary pyogenic ventriculitis is rare and only few cases have been reported in the literature,thereby being easily misdiagnosed.The clinical course of2 cases was analyzed to improve the understanding of the diagnosis and management of this disease.