带状疱疹性脊髓炎临床分析

Clinical analysis of herpes zoster myelitis

目的探讨带状疱疹性脊髓炎的临床特点、诊断及治疗。方法对4例带状疱疹性脊髓炎患者的临床资料进行回顾性分析。结果 4例患者均有特征性皮疹及脊髓损害症状。3例以皮疹为首发,1例以脊髓节段性损害症状首发,3例表现为对称性或非对称性双下肢无力和感觉障碍,1例表现为一侧肢体麻木、抽搐,无肢体瘫痪,3例有括约肌障碍。均经脊髓MR证实,均行脑脊液检查,抗病毒及甲强龙治疗效果好,随访1年以上3例痊愈,1例留有双下肢轻瘫。结论脊髓炎是带状疱疹的少见并发症,多累及胸髓,少数累及颈髓,多表现为脊髓不完全性横贯性损害,症状多不对称,早期诊断及抗病毒和甾体类激素治疗效果好。

Objective To analyze the clinical features of herpes zoster myelitis. Methods Retrospective analysis were made to show the clinical data of 4 patients developing herpes zoster myelitis. Results 4 patients all showed vesicular rash and symptoms of segmental spinal lesion.The vesicular lesions were found prior to neurological symptoms in 3 cases and posterior to neurological symptoms in 1 case.The clinical manifestations of 3 patients showed symmetrical or asymmetrical paraparesis and sensory dysfunction.Anaesthesia and twitch of one side limbs existed in 1 patient,but there was no limbs paralysis.Impaired sphincter function were found in 3 cases.Spinal magnetic resonance imaging（MRI） and cerebrospinal fluid（CSF） analysis were conducted in all cases.After administration of acyclovir and methylprednisolone,the symptoms were significantly improvement.After more than 1 year follow-up,3 spatients were Complete recovery.But 1 patient was left with permanent paraparesis. Conclusions Myelitis is an uncommon complication of VZV infection which was often located in thoracic spinal cord,but sometimes in cervical spinal cord.The clinical manifestations were characterized by asymmetrical,incomplete but transverse impairments in spinal cord.Early diagnosis,early acyclovir and steroids treatment might be the most important prognostic factor.