肥厚性硬脑膜炎误诊为多组颅神经炎临床报告并文献复习  

A Clinical Report of Hypertrophic Cranial Pachymeningitis Misdiagnosed as Multi Cranial Neuritis and Literature Review

作　　者：李庭毅[1] 王小平[1] 盛飞[1] 李文辉[1] 李睿[1] 

机构地区：[1]孝感市中心医院神经内科,湖北孝感432000

出　　处：《临床误诊误治》2015年第2期61-64,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨肥厚性硬脑膜炎(hypertrophic cranial pachymeningitis,HCP)的发病原因、临床特点及诊治措施,以减少误诊误治。方法回顾性分析我院收治的1例误诊为多组颅神经炎的HCP的临床资料,并复习相关文献。结果本例因右侧头部胀痛9个月、视物双影7个月及视力、听力下降2个月入院。曾在当地医院就诊,诊断为多组颅神经炎,予糖皮质激素治疗症状好转,但在糖皮质激素减量过程中症状复发并加重。入我院后行头颅MRI检查见局部硬脑膜明显增厚并强化,强化的硬脑膜表现为"轨道征";硬脑膜活组织病理检查示硬脑膜增厚及非特异性炎性反应改变,诊断为HCP。予糖皮质激素加免疫抑制剂治疗患者病情得以控制。结论 HCP以慢性头痛、多组颅神经受损及共济失调为主要临床表现,头颅MRI增强扫描可见特征性硬脑膜强化表现,硬脑膜病理检查是其确诊的依据,糖皮质激素加免疫抑制剂为其目前主要治疗手段。Objective To explore the etiology,clinical presentations and its diagnostic and treatment methods of hypertrophic cranial Pachymeningitis（HCP）,so as to reduce misdiagnosis. Methods The clinical data of one HCP patient misdiagnosed as having multi cranial neuritis was respectively analyzed and the combining relevant documents were retrospectively reviewed. Results The patient complained of a headache for 9 months,double vision for 7 months and reduced vision and hearing for 2 months. The condition was misdiagnosed as multiple cranial neuritis in other hospitals,and the symptoms mentioned above were controlled after administration of Glucocorticoid. But in the process of reducing dose of Glucocorticoid,the patient had a relapse. The MRI of our hospital showed thickened dura mater and contrast-enhanced MRI showed typical track sign. There was non-specificity inflammatory reaction with meningeal biopsy. Finally,the patient was diagnosed as having HCP,and the condition was controlled after medication of Glucocorticoid and Immunodepressant. Conclusion The main clinical features of HCP are chronic headache,multiple cranial nerve palsy and ataxia. The reinforced scanning of MRI can show typical track sign. Meningeal biopsy is the basis of confirmed diagnosis. Glucocorticoid and Immunodepressant are the major treatment approach at the present.

关 键 词：硬脑脊膜炎 误诊 神经炎 

分 类 号：R742.9[医药卫生—神经病学与精神病学]