脑囊虫病的头痛诊断与治疗

THE DIAGNOSIS AND TREATMENT OF HEADACHE CAUSED BY CEREBRAL CYSTICERCOSIS

目的 :研究头痛在脑囊虫病的分型、诊断和治疗中的特点 ;方法 :观察了 1 40 0例脑囊虫病人 ,其中 730例以头痛为首发症状。本文对 730例头痛病人从脑囊虫病的分型、诊断、影像和治疗中观察了他们的特点 ;结果 :脑室型头痛以发作性为特点伴有Brun’s征 ;脑膜型头痛以持续性头痛为特点伴有发热 ;脑实质型以颅压高性头痛或非颅压高性头痛为特点。所有经药物治疗的囊虫病人均有头痛的加重反应 ;一般发生在药物治疗的平均 1 4天 ,头痛反应时间和程度与活囊虫的数量和药物剂量有关。结论 :头痛是脑囊虫病人鉴别诊断和治疗反应及预后判定的重要指标。

Objective: To observe characteristic of headache in diagnosis type and treatment of cerebral cysticercosis.Methed:1400 cases with cerebral cysticercosis were studied, in which 730 cases with headache (52.1%,730/1400).There are CT、MRI and immunological test of CSF(IHA,ELISA of cerebral cysticercosis) were made in all cases who were divided into intraventricular cysts type, meningeal type, parenchymal type and mixed type. They were treated by operation and medication (albendazole or praziquantel) according to increased intracranial pressure and normal intracranial pressure.Result: The headache of intraventricular cysts type (13.9%, 102/730) is characterized in Brun's sign; Meningeal type (17.6%, 129/730) characterized with fever(25%), meningeal sign (62.7%),obstructive hydrocephalus(39.5%), IHA of CSF is 100% positive; Parenchymal cysts type (25.2%, 184/730) characterized in constant headache with increased intracranial pressure (98/184,53.2%); Others were mixed cysts type (43.1%, 315/730). In all cases treated by Albendazole or Praziquantel, aggravation of the headache occurred, during the average from 1 to 4 days (92%). In the most of patients(88%), headache disappeared after repeating 3～5 periods of treatment, but concentration of IHA in CSF increased and kept 1～3 years. Conclusion: Headache is one of significant criteria on differential diagnosis, effect of treatment and prognosis of neurocysticercosis.