神经系统囊虫病的临床特点

Clinical characteristic of neurocysticercosis

目的通过总结分析经临床确诊的307例患脑囊虫病患者的病历资料,探讨神经系统囊虫病的临床特点,并提出新的临床分型建议。方法分析、研究脑囊虫病患者的性别、年龄、感染史、临床表现、血清或脑脊液囊虫免疫学检查及CT或MRI影像学改变。结果本组神经系统囊虫病患者男性188例、女性119例,平均年龄40.26岁。有排绦虫史者78例。最常见的临床症状是癫痫,头痛头晕次之。其它症状则表现为单纯头晕、感觉异常、脑膜刺激征、意识障碍、偏瘫、失语、痴呆和截瘫。血清间凝实验检查者阳性率为68.50%。血清酶联免疫吸附试验者阳性率为80.90%。CT影像改变主要有脑积水、脑膜肥厚、脑内多发大小不等囊状低密度影、多灶性钙化、环状强化等。CT征象可单独出现或同时有两种及两种以上征象并存。MRI征象有脑积水、脑内多发和单发病灶。根据其临床症状、体征、影像学检查临床分型主要为癫痫型、头痛头晕型、偏瘫型、脑积水型、高颅压型、脑膜炎、颅内占位型、脊髓型。结论本组神经系统囊虫病患者多为青壮年。临床类型中以癫痫型最多见,除传统分型外,我们认为应当补充头痛头晕型和偏瘫占位型。辅助检查中,CT与MRI影像学上的变化具有诊断意义,二者不能相互替代。酶联免疫吸附试验检出的阳性率高于间凝实验检出的阳性率。

Objective To discuss the clinical characteristics of neurocysticercosis（NCC） ,and present the brandnew view of clinical classification of Neurocysticercosis in this research,by analysing the data from 373 patients who were infected by the larvae of Taenia solium. Method All the data included clinical presentations （gender, age, history of infection, clinical manifestation） ,visualization of CT or MRI scans, and serologic tests or immunological tests for CSF. Result There were 188 males and 119 females in this cohort. The average age was 40.26. The predominant clinical symptom was seizure, followed by headache and dizziness,other symptoms are such as headache,paraesthesia,meningeal irritations, conscious disturbance, hemiplegia, anpia, dementia, paralegina. There were 137 cases whose indirect agglutination tests were positive,and the ratio was 68.50%. The positive ratio was 76.92% in the seral test,80.90% in the ELISA. The primary CT scan often shows as follows： hydrocephalus, meninges thickening, cystic lesions, calcification and cyclic enrichment, etc. Each CT-image would appear alone,or more than two of them exist together. MRI scannings are hydrocephalus,multiple lesions and single lesion in the brain. The clinical classification based on the clinical manifestation and neuroimaging showed that seizure and epilepsy, headache and dizziness, paralysis, hydrocephalus, intracranial pressure, meningitis, cranial occupations and spinal lesion form. Conclusion Epileptic seizure was the most common type. Besides the ordinary subtypes, the headache and dizzy types be added. The CT scanning and MRI are very important in the diagnosis of NCC,but one of them cannot instead the other. The proportion of ELISA seropositive is higher than indirect-agglutination seropositive.