5例带状疱疹性脊髓炎临床和影像学特征分析

Clinical and imaging features of varicella-zoster virus myelitis(5 cases)

目的分析带状疱疹性脊髓炎的临床和影像学特征。方法回顾性分析5例带状疱疹性脊髓炎患者临床和影像学资料。结果 5例患者均大于40岁,均出现典型带状疱疹皮疹,且皮疹与受累脊髓节段相对应,其中4例(4/5)患者以皮疹为首发表现,1例(1/5)患者先出现脊髓受累表现。脊髓受累主要表现肢体运动障碍5例(5/5)、感觉障碍4例(4/5)、括约肌功能障碍3例(3/5)。5例行脊髓MRI检查,全部可见髓内异常信号。3例患者行脑脊液水痘-带状疱疹病毒DNA检查,2例阳性。5例患者经阿昔洛韦联合糖皮质激素治疗后,有不同程度好转,未遗留明显后遗症。结论带状疱疹性脊髓炎好发于中老年患者,肢体运动障碍、感觉障碍、括约肌功能障碍是其主要临床表现,MRI检查有助于诊断,早发现、及时有效地治疗有利于预后且预后良好。

Objective To investigate the clinical and imaging features of patients with varicella-zoster virus （VZV） myelitis.Methods Clinical and imaging records of 5 patients with VZV myelitis from January 2008 to May 2013 were analyzed retrospectively.Results All the patients were over 40 years old,5 patients with VZV myelitis had characteristic zoster.The dermatome of the skin lesion was consistent with myelopathy segment in each patient.The initial presentations of 4 （4/5） patients were herpes zoster,1 patient developed myelitis before herpes zoster.Clinical manifestations included limb movement disorder （5/5）,sensory impairment （4/5）,sphincter dysfunction （3/5）.All the patients underwent spinal cord MRI scan and had T2 abnormal signal lesions.VZV deoxyribonucleic acid （DNA） in cerebrospinal fluid （CSF） was detected in 3 patients by polymerase chain reaction （PCR） amplification methods,2 cases were positive.Five patients received treatment with acyclovir and steroids,and symptoms of 5 patients were improved in different degrees,no major sequelae was noted.Conclusions VZV myelitis occurs predominantly in the elderly and limb movement disorder,sensory impairment,sphincter dysfunction appeared to be the frequent clinical manifestations.Early diagnosis and aggressive treatment are associated with better outcomes.