新型脑隐球菌临床和影像表现分析

Analysis of clinical and image nanifestations in cryptococcus neoformans

目的总结新型隐球菌颅内感染的临床特点及影像诊断。方法选择2006年1月～2012年10月收治的35例确诊的新型隐球菌脑膜炎或脑炎患者的发病规律和临床、影像特点进行回顾性的归纳、分析和总结。结果影像学表现:脑实质占位表现27例(77.1%),其中小脑占位1例(2.8%),单纯脑白质小斑片状低密度5例(14.3%),脑膜炎表现7例(20.0%)。增强检查:不规则强化20例,脑脓肿样强化8例,环状强化3例,花环样强化2例,可见壁结节2例,合并有脑回样强化7例,脑积水9例,可见钙化灶1例。所有患者均不同范围地出现低密度水肿带。27例行头颅MRI检查,均见异常信号。结论新型隐球菌颅内感染大多数以亚急性或慢性起病,临床表现、影像学检查均缺乏特异性。其诊断需要完善脑脊液或脑组织病原学检查或病理检查。

Objective To summarize the clinical features and image diagnosis of cryptococcus neoformans （CN） in in- tracranial infection. Methods The pathogenetic regularity, clinical and image characteristics from 35 patients admitted in our hospital with definite diagnosis as cryptococcus neoformans meningitis or encephalitis from January 2006 to Oc- tober 2012 were retrospectively analyzed and summarized. Results Images displayed there were cerebral parenchyma occupation in 27 cases （77.1%） including one case （2.8%） of cerebellar occupation, 5 cases （14.3%） of low density with small patch in simple white matter, and 7 cases （20.0%） of meningitis. After enhancing examinations, the number of irregular enhancement, brain abscess enhancement, ring enhancement, wreath-like enhancement, and mural nodule was 20, 8, 3, 2, and 2 respectively, together with gyrate enhancement （n=7）, hydrocephalus （n=9）, and visible calcifica- tion （n=1）. All cases presented with low density edema at varied range. 27 cases after brain magnetic resonance imag- ing （MRI） examinations showed abnormal signals. Conclusion The onsets of CN in intracranial infection were mostly in subacute or chronic. There are not specific clinical manifestations or imageological examinations. Its diagnosis re- quires etiological or pathological examinations in cercbrospinal fluid or brain tissues.