有癫痫发作的脑型血吸虫病的临床分析

Clinical Analysis of Cerebral Schistosomiasis with Epilepsy

98例有癫痫发作的脑型血吸虫病患者，经血清、脑脊液免疫学、脑电图、头部CT或MRI检查，结合疫水接触史及临床表现而确诊。经分析结果发现：癫痫发作形式与病变部位密切相关，额叶、顶叶和额顶交界部位病变以全面性（强直-阵挛性）发作或单纯部分性发作为主，颞叶病变以复杂部分发作多见。头部CT或MRI对脑型血吸虫病是必要的检查手段，对病变定位价值很大，但对定性有一定困难。血吸虫肉芽肿以大脑皮质多见，但对于病灶大，水肿严重有脑室受压或中线结构移位的患者，不易与颅内占位性病变区别，易造成误诊。提示：对脑型血吸虫病的诊断，应结合疫水接触史、临床表现、血和脑脊液免疫学检查、头部CT或MRI检查更为可靠。

Ninety-eight cases of cerebral schistosomiasis with epilepsy were studied. The diagnoses were made on the basis of clinical menifestation, history of exposure to schistosom-contaminated water, immunological studies of serum and cerebral spinal fluid, encephalogram, CT or MRI imaging of the brain. The data demonstrated that the types of seizures were closely related with the locality of schistosomal lesions. The lesions within the frontal lobe,parietal lobe, or frontoparietal region of ten led to the seizures of grandmal or simple partial seizures, whereas, the lesions within the temporal lobe frequently produced the complex partial seizures. CT or MRI scans were necessary to diagnose the disease, especially in the togological localization, but limited to identify the quality of lesions. The schistosomal lesion often appeared in the cerebral cortex. When the granulomou lesion was large enough to develop serious edema that would compress the ventricle system or lead to the deviation of centra1 line, it was very difficult to differentiate from other occupying lesions such as glioma. It was concluded that the diagnoses of cerebra1 schistomiasis should rely on the clinical manifestations, the history of exposure to schistosoma-contaminated water, the immunological studies of blood and cerebral spinal fluid and CT or MRI examination of the brain.