颅内占位的脑型肺吸虫病(附2例报告及文献复习)

Cerebral Paragonimiasis of Intracranial Space Occupying Lesions: Two Case Reports and Literature Review

目的报告2例以颅内占位为主要临床表现的脑型肺吸虫病病例,提高临床医生对脑型肺吸虫病的认识。方法收集2例(同一家庭)诊断明确的脑型肺吸虫病患者的临床体征、实验室和影像学检查、病理检查等临床资料,结合文献复习进行分析。结果病例1为14岁男性,以头痛、右手抓握无力起病,查体提示右侧锥体束受损。血常规提示嗜酸粒细胞明显升高;腹部增强CT检查提示肝多发稍低密度影,考虑寄生虫感染可能;胸部CT平扫示双上肺多发小结节;头颅MRI增强示左侧额顶叶炎性肉芽肿,脑肺吸虫病可能性大。血清寄生虫全套检测提示:肺吸虫阳性。临床诊断:脑型肺吸虫病。予吡喹酮治疗后,患者头痛缓解,右手握力明显恢复。病例2为7岁女性,以发作性左手不自主抽动起病。查体无特殊。血常规提示嗜酸粒细胞升高。头颅MRI示右侧额叶占位并瘤卒中;MRI增强示右侧额叶占位,考虑高级别胶质瘤。行手术切除病灶,术后病理证实为脑型肺吸虫。术后予吡喹酮治疗后,患者意识清楚、肢体活动可,无头痛,未再出现左手不自主抽动发作。结论在非流行区,头颅MRI表现为不规则出血伴明显水肿带,有不规则或环形增强,不应盲目诊断为肿瘤,应进一步做肺吸虫免疫学检查或手术活检。疑似脑型肺吸虫病例,推荐将MR SWI序列作为常规扫描,以提高"隧道征"的检出率。

Aim To report two cases of cerebral paragonimiasis with intracranial space occupying lesions as the main clinical manifestations, and improve the diagnosis of cerebral paragonimiasis. Methods The clinical manifestation, laboratory tests,imageological examination and pathological examination of two patients（in the same family） with well-defined cerebral paragonimiasis were collected and the related literatures was reviewed. Results Case 1 was a 14-year-old male with a headache and weakness in his right hand. The sign revealed that the right pyramidal tract was damaged. Blood routine showed that eosinophils increased significantly. Abdominal enhanced CT examination prompted a lower density of liver indicating parasitic infection. Chest CT scan showed double multiple pulmonary nodules. Head MRI enhancement of the left frontal parietal lobes inflammatory granuloma prompted the possibility of cerebral paragonimiasis. Serum parasite full report prompted paragonimiasis positive. Clinical diagnosis was cerebral paragonimiasis. Headache was relieved after the praziquantel treatment, and the right hand gripwas recoveried. Case 2 was a 7-year-old female who developed episodes of episodic left-handed involuntary movements. No special signs were examed. The blood routine indicated eosinophils increased. Head MR scan showed the right frontal gyrus occupying and tumor strokes. Head MRI enhancement scan showed the right frontal mass, indicating high-grade glioma. Surgical resection of the lesions was carried out, post operative pathology confirmed the diagnosis of cerebral paragonimiasis. After the praziquantel treatment, the patient＇s consciousness, limb activities were normal, and no headache occured. No left hand involuntary jitter seizures occured. Conclusion In non-endemic area, though the manifestations of head MRI were irregular hemorrhage with obvious edema zone, and irregular or annular enhancement, the case should not be diagnosed as tumor roughly, immunologic test or biopsy should be further done. In cases of suspected paragonimiasis, it is recommended that SWI sequence be used as a routine scan sequence to improve detection rate of the ＂tunnel sign＂.