脑干脑炎的临床与影像学特点  

Clinical and imaging features of brainstem encephalitis

作　　者：孙琦[1] 刘文[1] 王立[1] 

机构地区：[1]南京医科大学附属脑科医院神经内科,210029

出　　处：《临床神经病学杂志》2010年第4期267-269,共3页Journal of Clinical Neurology

摘　　要：目的探讨脑干脑炎(BSE)的临床与影像学特征。方法对11例BSE患者的临床资料进行回顾性分析。结果本组患者中7例发病前有上呼吸道感染史;急性起病9例,亚急性起病2例;临床表现眩晕8例,口齿不清、吞咽困难及呛咳7例,走路不稳6例,头痛及恶心呕吐各5例,复视及呃逆各3例,尿潴留2例;多个脑神经损害10例,锥体束征10例,小脑征8例,感觉长束征7例,Horner征3例,深昏迷1例。8例CSF检查中细胞数增高6例,蛋白含量增高4例;7例脑干听觉诱发电位检查中6例异常;MRI检查均显示脑干内有异常病灶,其中延髓9例、脑桥5例、中脑2例,累及脑干外的病灶中小脑及颈髓各2例,右脑桥小脑脚1例。经皮质类固醇激素等治疗后6例基本痊愈、3例明显好转,随访2～9年,9例无复发。结论 BSE患者多有前驱感染史;临床上以多个脑神经损害、长束征及小脑征为主;病灶位于延髓、脑桥多见,可累及脑干外邻近组织;颅脑MRI对诊断BSE具有重要意义;BSE多呈单相病程,多数患者预后良好。Objective To explore the clinical and imaging features of brainstem encephalitis （BSE）.Methods The clinical data of 11 patients with BSE were analyzed retrospectively.Results Of the enrolled patients,7 cases had the history of upper respiratory tract infections before the onset of the disease.9 cases were acute,and 2 cases were subacute onset.Among the patients,8 cases suffered from dizzy;7 cases suffered from anarthria,dysphagia and irritating cough;6 cases had unstable gait;5 cases had headache,nausea and vomiting respectively;3 cases suffered from diplopia and hiccup respectively;2 cases had uroschesis.10 cases suffered from multiple cranial nerves disfunction.10 cases had pyramidal sign.8 cases had cerebellum sign.7 cases had sign of spinothalamic tract.3 cases had Horner sign,and 1 case had been in coma.Cerebrospinal fluid （CSF） were examined in 8 cases,which showed abnormal leucocytosis in 6 cases and abnormal elevation of protein in 4 cases.The examination of brainstem evoked potential （BAEP） in 7 cases and showed that the 6 cases were abnormal.All the patients had lesions in brainstem based on MRI.Among them,the lesion was located in medulla in 9 cases,pons in 5 cases,midbrain in 2 cases,cerebellum in 2 cases,cervical spinal cord in 2 cases and right pedunculus cerebellaris pontinus beyond the brainstem in 1 case.The 6 patients were almost cured after treatment with corticosteroid etc.,and 3 patients got obvious improvement.The 9 cases did not relapse in follow up 2-9 years.Conclusions Most BSE patients have infections history.The principal clinical features are multiple cranial nerves injury,sign of pyramidal and spinothalamic tract,and cerebellum sign.Lesions of BSE be located in medulla and pons mostly,and seldom in tissue beyond the brainstem.Cranial MRI is important to diagnosis of BSE.The BSE course is monophasic mostly.The prognoses of most BSE patients are good.

关 键 词：脑干脑炎 临床表现 影像学 

分 类 号：R742.9[医药卫生—神经病学与精神病学]