脊髓蛛网膜下腔梗阻1例病例分析  

Case Analysis of a Patient with Obstruction of Spinal Subarachnoid Space

作　　者：周成丞[1] 吴刚[1] 郑佳骏[1] 黄峰平[1] 周范民[1] 郑康[1] 

机构地区：[1]复旦大学附属华山医院神经外科,200040

出　　处：《中国临床神经科学》2013年第1期115-120,共6页Chinese Journal of Clinical Neurosciences

摘　　要：目的探讨椎管内囊虫的疾病特点。方法回顾性分析1例椎管内囊虫病患者的临床表现、影像学资料、手术方式、病理报告、免疫学检查和治疗经过,并复习相关文献和总结椎管内囊虫的诊治。结果患者因双下肢进行性、上行性麻木伴行走不稳入院。胸腰椎MRI在T8-9椎体椎管内髓外硬膜下可见条片状异常信号,伴上段蛛网膜下腔扩张和下段脊髓表面蛛网膜强化。术中见硬膜下多个囊性病灶,取出病灶后可见大量脑脊液涌出。术后病理考虑为寄生虫感染性肉芽肿。进一步检查血清囊虫抗体示弱阳性,予吡喹酮治疗,患者恢复良好。结论椎管内囊虫病罕见,诊断需结合患者的临床表现、影像学和免疫学资料,以免误诊误治。Aim To explore the feature of intraspinal cysticercosis. Methods A case of intraspinal cysticercosis was analyzed retrospectively, including clinical manifestation, images of MR, surgical procedures, pathological report, serum immunological reaction and chemotherapy of praziquantel. The literature was reviewed meanwhile to summarize the management of the disease. Results The patient was admitted to our hospital because of progressive numbness in both legs and stumbling gait. MRI study of the thoracic and lumbar spine revealed abnormal signals at T_8-9 level of subdural extramedullary space with the shape of puncture and patch. The upper subarachnoid space was enlarged and the lower surface of spine was enhanced with contrast. In the operation, several cystic lesions were found under the dura. After the removal of lesions, cerebrospinal fluid flowed out. The pathologic report showed parasitic infectious granuloma. Serous antibody of cysticercosis was weekly positive. The patient was treated with praziquantel and recovered well. Conclusion Intraspinal cysticercosis is uncommon, diagnosis may be based on the clinical manifestation, neuroimaging and immunological data.

关 键 词：囊虫病 脊髓 椎管内 蛛网膜下腔 神经外科 

分 类 号：R532.33[医药卫生—内科学]