肥厚性硬膜炎的临床和影像学特点

Clinical and imaging features of hypertrophic pachymeningitis

目的探讨肥厚性硬膜炎(HP)的临床及影像学特征。方法回顾性分析10例HP患者的临床资料。结果 10例患者以亚急性或慢性起病,8例患者继发于感染等自身免疫性疾病。以头痛(8例)或复视(2例)为首发症状。主要临床表现为头痛9例;脑神经麻痹7例;癫痫、共济失调、双下肢无力伴针刺觉减退各1例。MRI示硬膜异常肥厚,呈长或等T1、短T2信号;MRI增强示增厚的硬脑膜明显强化,呈条带状或结节状,不深入脑沟脑回。9例予以皮质类固醇激素治疗,头痛症状均缓解,遗留周围性面瘫4例,视物及听力障碍各1例。结论 HP多为继发性,以头痛及脑神经麻痹为主要症状,MRI平扫及强化可见条带状或斑块状硬膜肥厚,可累及硬脑膜和/或硬脊膜,糖皮质激素治疗有效。

Objective To explore the clinical and imaging features of hypertrophic pachymeningitis （HP）. Methods The clinical data of 10 HP patients were analyzed retrospectively. Results Ten HP patients were subacute or chronic. Eight patients were secondary to infection and other autoimmune diseases. Headache （8 cases） and diplopia （2 cases） were the first symptoms. The main manifestations involved headache in 9 cases; cranial nerve palsy in 7 cases; and epilepsy, ataxia, lower extremity weakness associated with paraesthesia in 1 case respectively. MRI showed thickened dura mater in 4 cases; contrast-enhanced MRI showed the thickened dura mater had an obvious enhancement in a handed or nodular pattern, Without extending to the sulci gyms. Nine patients were treated ,with cortieosteroids, and then headache were relieved. Four cases leave behind peripheral facial paralysis, and vision and hearing impairment in 1 case respectively. Conclusions Most HP patients are secondary. Headache and cranial nerve palsy are the main symptoms in HP. Plain scanning and contrast-enhancedMRI are thickened dura mater in a banded or nodular pattern, involving the dural and/or spinal. Glucoeorticoid treatment is effective.