隐匿性脑脓肿临床误诊分析

Analysis on clinical misdiagnosis of latent brain abscess

目的分析临床隐匿性脑脓肿的误诊原因。方法收集2010年1月-2016年12月华中科技大学同济医学院附属同济医院神经外科诊治的39例临床误诊的脑脓肿患者的临床资料,分析其临床特点,误诊原因及治疗体会。结果 39例脑脓肿患者术前行影像学检查,MRI增强表现为非典型环形强化病灶28例(71.8%),不均匀轻度强化病灶11例(28.2%)。39例患者术前误诊为胶质瘤22例,星形细胞瘤5例,转移瘤6例,神经元肿瘤1例,梗塞后出血1例,海绵状血管瘤1例,胆脂瘤1例,颅咽管瘤1例,脑膜瘤1例。39例患者中开颅病灶显微切除35例,立体定向手术4例。32例患者随访(28.5±18.5)个月,疗效良好,MRI复查显示病灶根治无复发者26例,占86.7%。结论不明确的感染病程、非特异性的临床表现,不典型的实验室和影像学检查结果是脑脓肿误诊的原因。对于临床疑似患者,术中预防脓液外溢播散,根治病灶可以获得良好的疗效。

Objective To analyze the causes for misdiagnosis of latent brain abscess.Methods Clinical data of 39 patients with misdiagnosed brain abscess hospitalized in our department from Jan. 2010 to Dec. 2016 were collected. The collected data, including clinical features, misdiagnosis reasons and treatment experience, were analyzed retrospectively.Results All the patients received preoperative contrast enhanced magnetic resonance imaging(MRI) examination. Atypical ring-enhancing lesions and heterogeneous enhancing lesions were detected in 28(71.8%) and 11(28.2%) patients. They were misdiagnosed preoperatively as glioma(n=23), astrocytoma(n=5), metastatic tumors(n=6), infarcted hemorrhage(n=1), cerebral cavernous hemangioma(n=1), cholesteatoma(n=1), craniopharyngioma(n=1) or meningioma(n=1). Stereotactic surgery was performed in 4 patients and craniotomy for abscess removal in 35. 32 patients were followed up for 28.5±18.5 months postoperatively, and 26(86.7%) got good prognosis without abscess recurrence.Conclusions The reasons for misdiagnosis of brain abscess included uncertain course of infection, non-specific clinical manifestations, atypical blood-test results and MRI findings. To achieve the best prognosis for suspected cases, total abscess resection without pyogenic fluid leakage should be performed.