带状疱疹性脊髓炎1例并文献复习

One Case Report of Varicella-Zoster Virus Myelitis and Literature Review

目的分析带状疱疹性脊髓炙的临床和影像学特征。方法报告本院诊治的1例带状疱疹性脊髓炎,并复习近年来国内外文献报道的资料相对完整的82例病例。结果本例为48岁男性患者,在右胸背部出现典型带状疱疹皮损后7d出现胸髓受累表现,经阿昔洛韦联合糖皮质激素治疗后完全恢复。既往文献共报告82例类似患者,91.57%(76/83)出现带状疱疹皮损,88.16%(67/76)脊髓受累节段与皮损分布的部位相对应,6例在皮损的远隔部位,3例继发于播散型带状疱疹。86.75%(72/83)行MRI检查,56例(77.78%)可见相应脊髓节段受累,30例(61.22%)患者胸段脊髓受累,其主要表现为肢体运动障碍(80/83)、感觉障碍(70/83)或/和括约肌功能障碍(46/83)。90.36%(75/83)例患者抗病毒治疗,79.52%(66/83)预后较好。结论带状疱疹性脊髓炎好发于中老年患者,易累及胸髓,早发现、及时有效的治疗,预后较好。

Objective To analyze the clinical and imaging features of varicella-zoster virus myelitis. Methods One case from our hospital and 82 cases reported in literatures were reviewed retrospectively. Results We reported here a 48-year-old male developed thoracic myelitis 7 days after he had varicella-zoster. The patient was completely recovered after anti-herpetic agents and glucocorticosteroid treatment. Seventy-six out of 83 （91.57%） , including 82 previously reported patients with varicella-zoster virus myelitis had varicella-zoster lesions. The dermatomal distribution of skin lesions was the same as myelitis involved region in 67 patients. Six patients had myelopathy at the distant site from zoster. Three patients had disseminated herpes. Among 72 patients underwent spinal cord MRI scan, 56 suffered from spinal cord disorder, 30 patients occurred mainly in the thoracic segment. Clinical manifestations included limb movement disorder （80/83） , sensory impair- ment（70/83） and/or sphincter dysfunction（46/83 ）. Seventy-five patients received treatment with anti-her- petic agents, and good prognosis was achieved in 66 of total（83） patients. Conclusion Varicella-zoster vi- rus myelitis occurs predominantly in the elderly and the thoracic segment of the spine is often involved. Early diagnosis and aggressive treatment could yield better outcomes.