神经型布氏杆菌病四例

Four cases of neurobrucellosis

目的分析神经型布氏杆菌病患者的临床表现、实验室检查、影像学表现等临床特点,提高对本病的认识。方法对4例神经型布氏杆菌病患者的临床资料进行分析。结果 4例患者均为男性;血清凝集试验≥1:100;以肢体无力、走路不稳、听力减退、视物模糊、小便潴留及便秘等神经系统症状为主要临床表现,部分患者合并肝功能异常、脾肿大;头颅DWI未见异常1例(例1),头颅CT示基底核区梗死灶1例(例2),头颅MRI示双侧额叶皮质下及双侧岛叶散在缺血灶1例(例3),胸椎MRI示颈胸髓异常信号1例(例4);3例(例1、例2、例4)患者头痛、肢体无力等症状好转,1例(例3)患者随访1年余走路仍不稳。结论神经型布氏杆菌病以肢体无力、走路不稳等神经系统症状为主要的临床表现,同时可合并肝功能异常、脾肿大;中枢神经系统影像学可以表现为脑缺血灶、梗死灶、脊髓脱髓鞘改变,也可以正常;血清学检查对诊断具有重要的意义;早期规范治疗,预后一般较好。

Objective Exploring the clinical manifestations, laboratory tests, imaging characteristics of the neurobrueellosis to improve the understanding of the disease .Methods To analyze the clinical datas of the four patients with neurobrucellosis.Results Neurobrucellosis occurs in four males;serological agglutination test titers of ≥1：100 ;there were many different neurologic clinical manifestations, for example, weakness of limbs, walking instability, hearing loss, blurring of vision, urine retention and constipation so on, someone can occur the complications of dysfunction of liver and splenomegaly;the brain DWI of the first patient＇s was normal, the brain CT of the secend one was infarction in the basal ganglia, the brain MRI of the third one was ischemia of the bilateral frontal subcortical and insula and the fourth were abnormal signal in the cervical spinal and chest pulp MRI, the clinical festures of the three cases （the first, the secend and the fourth）, for example, headaches,limb weakness recovered, but the other one （the third） left walking instability after more than one year. Conclusion The main clinical manifestations of the neurohrucellosis are neurologic deficits ,for example ,weakness of limbs and walking instability so on ,meanwhile it can occur the complications of dysfunction of liver and splenomegaly; imaging characteristics of CNS may be cerebral ischemia and infarct, demyelination in spinal cord or normal;serological detections is important for the diagnosis;if it is treated early , the prognosis is generally good.