25例脑脉管炎临床资料分析

Clinical Analysis of 25 Cases With Cerebral Vasculitis

目的:探讨脑脉管炎的临床特征、血清学及影像学特点以指导临床诊疗。方法:回顾性分析25例拟诊为脑脉管炎患者的临床资料,结合近年文献讨论脑脉管炎的特点。结果:25例患者中40～50岁发病数最多。发病与钩端螺旋体感染有关。临床主要表现为脑病、头痛和不同程度的局灶性神经体征。MRI示颅内病变多累及皮层和皮层下,多发病灶22例(88%),单发病灶3例(12%)。血管影像学检查示25例患者均表现为血管节段性狭窄或闭塞,且通常累及颅内多支血管,尤集中于Willis环周边血管。25例经激素治疗后均临床好转出院。结论:结合临床特点、既往史、血清学和影像学检查,排除相似疾病可拟诊脑脉管炎,一旦拟诊需尽早行激素及对症治疗。

Objective： To investigate the clinical feature, serological and radiological features of cerebral vasculitis in order to help clinical diagnosis and treatment. Methods： Clinical data of 25 patients with suspected cere- bral vasculitis were analyzed retrospectively, and the feature of cerebral vasculits was discussed with literatures review. Results： Patients between 40-50 years old constituted the majority of the 25 patients, and may be related with the leptospira infection. Encephalopathy, headache and focal neurological signs of various degrees were the main manifestations. MRI showed intracranial lesions involved mostly cortical and subcortical region, in which multiple lesions and single lesion were 22 （88%） and 3 （12%） cases, respectively. In all 25 cases, cerebral angiogram disclosed stenotic segments or occlusion of the vessels which often involved multiple blood vessels especially the ones of the circle, of Willis. All patients showed a clinical improvement after the treatment with corticosteroids and discharged. Conclusions： A suspected diagnosis of cerebral vasculitis based on excluding other similar diseases by clinical manifestations, history, serological and radiological examination. Once the suspected diagnosis is made, corticosteroid and symptomatic treatments should be used as early as possible.