以累及胼胝体为特点的急性播散性脑脊髓炎一例诊治分析  

Diagnosis and Treatment for A Case with Acute Disseminated Encephalomyelitis Involved Corpus Callosum Lesions

作　　者：王新[1] 焦立影 王喜慧 王银霞[3] 李春阳[3] 

机构地区：[1]内蒙古医科大学,内蒙古自治区呼和浩特市010030 [2]内蒙古巴彦淖尔市杭锦后旗人民医院神经内科 [3]内蒙古医科大学附属医院神经内科

出　　处：《实用心脑肺血管病杂志》2016年第11期96-99,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：国家自然科学基金(81360213)

摘　　要：本文报道了1例以累及胼胝体为特点的急性播散性脑脊髓炎(ADEM)患者,该患者主诉为"出差劳累后出现头痛伴恶心2 d",发病初期即出现头痛、发热、意识障碍及脑膜刺激征,腰椎穿刺结果提示高颅内压,脑脊液蛋白含量增高、细胞数增多、糖及氯化物含量降低;病情加重后并发严重电解质紊乱、呼吸衰竭;治疗过程中出现尿崩症,较明显的神经病理性疼痛;后经过反复多次颅脑、颈椎、胸椎磁共振成像(MRI)检查并结合临床症状确诊为ADEM,经大剂量甲强龙及丙种球蛋白反复冲击治疗后病情好转,但遗留严重双下肢无力症状并继续行康复治疗。以累及胼胝体为特点的ADEM患者较为少见,应引起临床高度重视并注意与结核性脑膜炎等疾病进行鉴别。This review reported a case with acute disseminated encephalomyelitis involved corpus callosum lesions, whose chief complaint was ＂ fatigue - induced headache and nausea for 2 days after business trip＂. At the early stage, the patients occurred headache, fever, disturbance of consciousness and meningeal irritation sign, the lumbar puncture results showed increased intracerebral pressure, cerebrospinal fluid protein and cell counts, decreased cerebrospinal fluid sugar and chloride content; caused by aggravation of disease, the patient complicated with severe electrolyte disorder and respiratory failure; during the treatment, the patient occurred insipidus and obvious neuropathic pain. After repeated MRI examinations for brain, cervical vertebra and thoracic vertebra and combination of clinical symptoms, the patient finally diagnosed as acute disseminated encephalomyelitis, after repeated implosive therapy of methylprednisolone and gamma globulin, the patient received an improvement of the disease, but left severe lower extremities weakness and continuously received rehabilitation treatment. Acute disseminated encephalomyelitis involved corpus callosum lesions is rare on clinic, which should be pay more attentions to and identify with tubercular meningitis.

关 键 词：脑脊髓炎 胼胝体 结核 脑膜 

分 类 号：R744.3[医药卫生—神经病学与精神病学]