急性出血性白质脑炎的诊治分析

Analysis of diagnosis and treatment of acute hemorrhagic leukoencephalitis

目的探讨急性出血性白质脑炎的临床表现、影像学特征及治疗方案。方法对收治的1例急性出血性白质脑炎患者的临床表现、辅助检查及诊断和治疗经过进行分析,讨论其特征。结果患者29岁男性,发热伴头痛、精神行为异常15d,意识障碍13d,初步诊断为脑脓肿,给予美罗培南抗感染和其他对症支持治疗后好转不明显,之后行脑组织活检提示脱髓鞘改变,给予糖皮质激素治疗后病情明显好转。结论急性出血性白质脑炎临床上极其罕见,病程进展快,预后差,死亡率高,一旦确诊,应及时给予糖皮质激素冲击治疗。

Objective To explore the acute hemorrhagic leukoencephalitis＇ clinical features,imaging manifestations and treatment method. Methods A rare case acute hemorrhagic leukoencephalitis was reported. His clinical presentation,laboratory results,diagnosis and treatment were discussed. Results The patient was a male,29 years old,had a fever with headache,behavior disorders for 15 days,disturbance of consciousness for 13 days,and the preliminary diagnosis was brain abscess,meropenem and life-support therapy was given,but the clinical manifestation has no obvious improvement after the treatment. Then brain tissue biopsy suggested demyelinating changes. Condition improved markedly while glucocorticoid treatment was given. Conclusion Acute hemorrhagic leukoencephalitis is a rare condition,characterized by rapid progression,poor prognosi and high mortality. Once diagnosed,glucocorticoid should be at the first place.