初诊为抑郁症的老年隐球菌性脑膜炎6例报告  

Clinical Characteristics of 6 Cases of Elderly Cryptococcal Meningitis Patients Misdiagnosed as Depressive Disorder

作　　者：陈鹭玲[1] 宁金环 彭锋[1] 庄晓荣[1] 陈星宇[1] 郑维红[1] 刘肇绩[1] CHEN Luling;NING Jinhuan;PENG Feng;ZHUANG Xiaorong;CHEN Xingyu;ZHENG Weihong;LIU Zhaoji(Zhongshan Hospital of Xiamen University,Xiamen 361004,China)

机构地区：[1]厦门大学附属中山医院,福建厦门361004 [2]厦门大学医学院

出　　处：《中外医学研究》2019年第33期179-181,共3页CHINESE AND FOREIGN MEDICAL RESEARCH

基　　金：福建省厦门市科技局资助项目(项目编号：3502Z20084019)

摘　　要：目的:探讨老年隐球菌性脑膜炎发病特点和误诊原因。方法:分析6例初诊为抑郁症的老年隐球菌性脑膜炎患者的临床表现、脑脊液特点、治疗和预后表现,以明确发病特点和误诊原因。结果:6例病例初期均表现为头晕、失眠、食纳减少;后期出现颅内感染相对特异症状:认知障碍5例、头痛3例、肢体无力3例、发热2例。脑脊液隐球菌培养阳性明确诊断,抗真菌治疗有效。6例均好转,但是2例患者遗留明显后遗症:1例患者遗留明显的认知障碍和双下肢活动受限,1例双眼失明,2例确诊时间为2、4周。结论:老年患者患病后临床症状常不典型,当一种疾病不能解释所有症状时,需开拓思路,积极完善相关检查,必要时请相关科室协助诊治,尽量减少误诊。Objective: To explore the clinical characteristics of cryptococcal meningitis and causes of misdiagnosis. Method: To define the clinical manifestations, cerebrospinal fluid characteristics, treatment and prognosis of 6 elderly patients with cryptococcal meningitis misdiagnosed as depressive disorder, in order to clarify the characteristics of the disease and the causes of misdiagnosis. Result: The 6 cases showed dizziness,insomnia and food unsatisfied in the early stage. They were treated with antidepressant treatments. In the develepmemt of disease, there were relatively specific symptoms of intracranial infection: cognitive disturbances was observed in 5 cases, headache in 3 cases, limb weakness in 3 cases, fever in 2 cases. Cerebrospinal fluid positive cryptococcal cultures and antifungal treatment were effective confirmed cryptococcal meningitis. 6 cases were all improved, but 2 patients had significant sequelae left: 1 patient had significant cognitive impairment and limited lower extremity activity, 1 case was blind, and above 2 cases were diagnosed for 2 or 4 weeks. Conclusion: The clinical symptoms are often atypical in elderly patients. When a disease can not explain all of the symptoms, it is necessary to develop ideas, actively improve the relevant examinations, and if necessary, ask the relevant departments to assist in the diagnosis and treatment, and minimize misdiagnosis.

关 键 词：隐球菌性脑膜炎 抑郁症 老年患者 

分 类 号：R74[医药卫生—神经病学与精神病学]