以神经系统症状为首要表现的结节病1例并文献复习  

A case of sarcoidosis with neurological symptoms as the primary manifestation and literature review

作　　者：陈国华 苏士成[1] 李红[1] CHEN Guohua;SU Shicheng;LI Hong(Pulmonary Disease Department,Kunshan Hospital of Chinese Medicine,Kunshan 215300,China)

机构地区：[1]昆山市中医医院肺病科,江苏昆山215300

出　　处：《临床医学研究与实践》2024年第15期9-12,共4页Clinical Research and Practice

摘　　要：目的 回顾1例以神经系统症状为首要表现的结节病诊治经过并行文献复习,提高对神经系统结节病认识,以期减少误诊。方法 回顾我院初诊的神经系统结节病患者临床资料,分析诊疗经过及转归,搜索国内外相关文献,探究疾病的发病率、临床表现、影像特点、诊断标准及治疗方案。结果 患者因“头痛头晕”就诊,头颅MRI提示双侧额、颞、枕顶软脑膜区多发异常信号影,PET-CT提示可活检肺部病灶,气管镜活检明确肉芽肿性炎症,完善实验室检查排除恶性肿瘤、特异性感染等疾病,诊断结节病后经全身糖皮质激素治疗,患者症状好转,复查头颅MRI及胸部高分辨CT改善。结论 神经系统结节病临床表现无特异性,头颅MRI可作为首选检查,确诊需有活检病理证实非坏死性肉芽肿性炎症,同时排除可引起类似病理改变的其他疾病,糖皮质激素是该病的首选治疗方案。Objective To retrospect the diagnosis and treatment of a case of sarcoidosis with neurological symptoms as the primary manifestation and literature review,improve the understanding of sarcoidosis of the nervous system in order to reduce misdiagnosis.Methods The clinical data of patients with neurological sarcoidosis newly diagnosed in our hospital were reviewed.The diagnosis and treatment process and prognosis were analyzed,and the relevant literatures at home and abroad were searched to explore the incidence,clinical manifestations,imaging characteristics,diagnostic criteria and treatment options of the disease.Results The patient was admitted in the hospital due to'headache and dizziness'.The head MRI showed multiple abnormal signal shadows in the bilateral frontal,temporal and occipital parietal leptomeningeal regions.PET-CT suggested that the lung lesions could be biopsied.Tracheoscopic biopsy confirmed granulomatous inflammation.The laboratory examination was performed to exclude malignant tumors,specific infections and other diseases.After the diagnosis of sarcoidosis,the patient was treated with systemic glucocorticoids.The patient's symptoms improved,and the review of head MRI and chest high-resolution CT showed inprovement.Conclusion The clinical manifestations of neurological sarcoidosis are not specific.Head MRI can be used as the first choice.The diagnosis needs to be confirmed by biopsy pathology to confirm non-necrotizing granulomatous inflammation,and other diseases that can cause similar pathological changes are excluded.Glucocorticoid is the first choice for the treatment of the disease.

关 键 词：神经系统 结节病 肉芽肿 

分 类 号：R747.9[医药卫生—神经病学与精神病学]