孤立性蝶窦炎的神经系统表现

Neurological manifestations of isolated sphenoiditis

目的 探讨孤立性蝶窦炎的神经系统表现 ,为临床诊断和鉴别诊断提供参考。方法 分析北京协和医院 1995年 6月～ 2 0 0 1年 1月收治的 11例孤立性蝶窦炎和 3例蝶窦后组筛窦炎病例的临床症状、体征、影像学资料、诊断和治疗结果。结果 14例中主诉头痛 12例 ,视力下降和 /或复视7例 ,涕中带血 3例 ,脓涕 2例 ,眼球突出、眼球固定和咽痛各 1例。检查 6例有Ⅱ和 /或Ⅲ、Ⅳ、Ⅵ颅神经损害 ;1例对侧偏瘫 ,失语 ;余未见其他神经系统改变 ;所有病例的鼻科检查中只有 5例的鼻腔所见提示后组鼻窦病变。CT和 /或MRI发现 13例单侧、1例双侧蝶窦炎 ,3例同侧后组筛窦炎。 14例中并发累及患侧额叶、颞叶、顶叶和脑干的大范围颅内感染、海绵窦段颈内动脉血管瘤和脑脊液鼻漏各 1例 ;视神经炎 4例 ,其中 1例为双眼 ,眶内蜂窝织炎和眶尖综合征各 1例 ;2例并发外展神经麻痹。全部行鼻内窥镜下蝶窦开放病变切除术 ,部分病例同时抗感染治疗 ,除 1例广泛颅内感染脑疝死亡外 ,头痛全部缓解。结论 以孤立性蝶窦炎为主的后组鼻窦炎是一直存在而未被充分认识的一个疾病 ,它可仅有以头痛为主诉的神经系统症状 ,并可引起严重的神经系统并发症 ,因此 ,在头痛的诊断和鉴别诊断中蝶窦炎是不可忽略的因素。

Objective To review the neurological manifestations of isolated sphenoiditis. Methods The symptoms, signs, imaging data, diagnoses and outcomes of 14 cases with sphenoiditis hospitalized in Peking Union Hospital June 1995 ～ January 2001 were analyzed retrospectively. Results The chief complaints of this group included headache (12 cases),visual loss and/or diplopia (7 cases), blood in nasal discharge (3 cases), purulent nasal discharge (2 cases), exophthalmoptosis (1case),fixation of eyeball (1case), and pharyngodynia (1 case). Six patients presented deficits of the second and/or third, fourth, and sixth cranial nerves; one patient had hemiplegia and aphasia; no more presentation of nervous system was found in all patients. Only five patients showed signs of posterior sinusitis in rhinologic examination. CT and/or MRI revealed isolated sphenoiditis (11 cases) and sphenoiditis with posterior ethmoiditis (3 cases). The complications of this group were intracranial infection involving frontal, temporal, and parietal lobes and brainstem (1 case), aneurysm of cavernous carotid artery (1 case), nasal cerebrospinal fluid leakage (1 case), optic neuritis (5 eyes), abducent paralysis (2 cases), orbital cellulitis (1 case) and orbital apex syndrome (1 case). All of the patients underwent endoscopic sphenoid surgery. 13 patients were free of headache after surgery. One patient died because of hernia of brain. Conclusion Headache can be the first or unique symptom of isolated sphenoiditis. Isolated sphenoiditis should be considered in diagnosis and differential diagnosis of headache. CT and MRI are the best tools in diagnosis of isolated sphenoiditis.