糖尿病并发脑脓肿3例临床分析

Clinical features of brain abscess complicated by diabetes

目的报告3例糖尿病合并脑脓肿病例,并分析其临床特点。方法提供并综合分析病史、临床表现、体格检查以及影像学检查结果。结果病例1为2型糖尿病(T2DM)合并脑卒中样发作的脑脓肿,初诊为脑囊虫病或脑血管疾病。病例2为T2DM并发脑脓肿患者,以癫痫发作为首发症状。病例3为T2DM合并小脑脓肿患者,初诊为小脑肿瘤。结论糖尿病合并脑脓肿的临床表现常不典型,多为隐源性脑脓肿,容易被误诊。对糖尿病患者出现的脑部占位病变,须除外脑脓肿;糖尿病患者出现的任何脑卒中都应和罕见的“脑卒中样”发病的脑脓肿进行鉴别。

Objective To report 3 cases with brain abscess in patients with type 2 diabetes and to analyze their clinical features. Method Provided and analyzed were the case history, clinical manifestations, and the results of physical and imaging examinations. Results “Stroke-like” onset of cerebral abscess in a 48-year-old male with type 2 diabetes was initially misdiagnosed as “cerebral cysticercosis or cerebral vascular disease”. Epileptic onset was the first symptom of brain abscess in a 43-year-old female with type 2 diabetes. Orogenic cerebellar abscess which presented in a 34-year-old male with type 2 diabetes was initially misdiagnosed as “cerebellar tumor”. Conclusion The clinical characteristics of diabetes-complicated brain abscess are usually atypical and cryptogenic. Therefore, brain abscess in patients with type 2 diabetes is easily misdiagnosed. Brain abscess should be ruled out from masses of brain presented in patients with diabetes, and stroke-like onset of brain abscess should be differentiated from any stroke onset in type 2 diabetes patients.