以颅内出血为首发症状的儿童肺吸虫脑病临床特点及误诊分析

Clinical features and misdiagnosis analysis of children with cerebral paragonimiasis with intracranial hemorrhage as initial symptom

目的探讨以颅内出血为首发症状的肺吸虫脑病患儿临床特点及误诊原因，提高对肺吸虫脑病的临床诊治水平。方法收集2011年1月至2015年12月在遵义医学院附属医院住院的以颅内出血为首发症状的肺吸虫脑病患儿资料。总结其临床、影像学及实验室特点，随访治疗效果及预后。结果符合肺吸虫脑病纳入标准者7例，其中男4例，女3例；年龄6—13岁（平均9．3岁）。均以头痛、呕吐急性起病；7例患儿头颅CT及MRI均提示颅内出血；7例患儿均入院在神经外科首诊为颅内出血，误诊为脑血管畸形。7例患儿中3例影像学示典型肺吸虫脑病环形征及隧道征。7例患儿中并胸部肺吸虫病5例，6例嗜酸性粒细胞增高，6例检出特异性抗体。7例患儿均予吡喹酮治疗，6例痊愈，1例遗留轻度左侧肢体功能障碍。结论儿童肺吸虫脑病临床异质性强，表现复杂多样，颅内出血可能为早期表现，应予重视；结合临床表现、血嗜酸性粒细胞增多、影像学特征及特异性抗体检查可早期诊断，并及时治疗。

Objective To explore the clinical characteristics and the cause of misdiagnosis of child suffering from cerebral parago-nimiasis with intracranial hemorrhage as initial symptom, and to improve the diagnosis and treat- ment level of cerebral paragonimiasis. Methods The clinical data of the children who suffered from cerebral parago- nimiasis with intracranial hemorrhage as initial symptom were collected from January 2011 to December 2015 in Affilia- ted Hospital of Zunyi Medical College. The clinical manifestation, imageology and laboratory tests, outcome of therapy were analyzed and then the effect of treatment and the prognosis were followed up. Results There were 7 patients meeting the inclusion criteria for cerebral paragonimiasis ,including 4 male and 3 female. They were from 6 to 13 years old witfi the average age of 9.3 years old. All patients presented witfi headache and vomiting, and showed intracranial hemorrhage through CT or MRI of brain. All of the 7 patients were misdiagnosed as eerebrovascular malformation by the neurosurgeons. Three of them showed typical imaging pattern including tunnel sign and the ring - like shape of cerebral paragonimiasis. Five of these cases were attacked by pulmonary distomiasis at the same time. Six of them had an increasing eosinophil, and the paragonimus antibody was positive. They were treated with Praziquantel. Six patients recovered completely, and 1 patient had the dysfunction of left extremities. Conclusions The childhood cerebral paragonimiasis has strong clinical heterogeneity and diversity in manifestation. Intracranial hemorrhage may be the initial symptom ,which should be paid more attention to. Cerebral paragonimiasis can be diagnosed and treated early according to the clinical characteristics, the increase of eosinophil,the typical changes in imageology and the specific antibody test.