肥厚性硬脑膜炎5例报道及文献复习VIP免费

©1994-2010ChinaAcademicJournalElectronicPublishingHouse.Allrightsreserved.http://www.cnki.net[收稿日期]2010202208[作者单位]蚌埠医学院第一附属医院1.神经内科,2.放射科,安徽蚌埠233004[作者简介]钱伟东(1967-),女,副主任医师,副教授.[文章编号]100022200(2010)0620564204·临床医学·肥厚性硬脑膜炎5例报道及文献复习钱伟东1,陈守康2,屈洪党1[摘要]目的:探讨肥厚性硬脑膜炎(hypertrophiccranialpachymeningitis,HCP)的临床、病理和影像学特点。方法:对5例HCP患者的临床资料结合文献进行回顾性分析。结果:5例患者均表现为头痛,其中2例伴言语障碍;1例伴肢体抽搐,反应迟钝,颅神经受损,行走不稳;1例伴记忆障碍。MRI平扫2例显示脑实质内有水肿改变,增强后5例硬脑膜广泛强化,尤其是额、顶部硬脑膜、大脑镰及小脑幕强化明显。1例行硬脑膜组织活检发现硬脑膜明显增厚,病理示硬脑膜纤维增生,大量浆细胞、淋巴细胞、巨噬细胞、嗜中性粒细胞浸润,灶性钙化,考虑为慢性非特异性炎;“硬膜下方”脑组织血管扩张,浆细胞、巨噬细胞为主的炎细胞浸润,相应部位脑实质也为非特异性炎性改变。结论:HCP的病因复杂,临床表现多有头痛、肢体抽搐、反应迟钝、言语障碍、记忆障碍、行走不稳、颅神经受损等症状;病理示硬脑膜纤维增生,炎细胞浸润,相应部位脑实质也可有非特异性炎性改变;头颅MRI增强发现典型的影像学改变有利于临床诊断。[关键词]硬脑膜炎;病理学,临床;影像学[中国图书资料分类法分类号]R515.2[文献标识码]AHypertrophiccranialpachymeningitis:areportof5casesandreviewoftheliteratureQIANWei2dong1,CHENShou2kang2,QUHong2dang1(1.DepartmentofNeurology,2.DepartmentofRadiology,TheFirstAffiliatedHospitalofBengbuMedicalCollege,BengbuAnhui233004,China)[Abstract]Objective:Todeterminetheclinical,pathologicalandradiologicalfeaturesofhypertrophiccranialpachymeningitis(HCP).Methods:Theclinicaldataof5patientswithHCPwerestudiedretrospectively,andtheliteraturewasreviewed.Results:Allthe5patientspresentedthesymptomofheadache.Twoofthemwereaccompaniedbylanguagebarriers,1bylimbconvulsion,reactionslowness,cranialnervedamageandwalkinginstability,and1bymemoryimpairment.MRIscanshowedthat2casesdisplayededemachangeswithinthebrainparenchyma,andtherewasawiderangeofenhancedthickeninginallthe5casesafterenhancement,particularlyatthefrontalandtopoftheduramater,thefalxandthetentorium.Thebrainbiopsyof1patientshowedthattheduramaterwassignificantlythickened,andtheduralfibrosispathologyindicatedtheexistenceofalargenumberofplasmacell,lymphocyte,macrophage,neutrophilinfiltrationandfocalcalcification,whichwasconsideredtobeanon2specificchronicinflammation.Thebrainbloodvesselsundertheduramaterweredilated,withplasmacellandmacrophageinfiltration.Thecorrespondingbrainparenchymaalsodisplayednon2specificinflammatorychanges.Conclusions:CausesofHCParecomplicated.Thecommonclinicalmanifestationsincludeheadache,bodyconvulsion,reactionslowness,speechimpairment,memoryimpairment,walkinginstabilityandcranialnervedamage;Pathologyshowedduralfibrosisandinflammatorycellinfiltration;thecorrespondingpartsofthebrainparenchymamayalsodisplaynon2specificinflammatorychanges,andsuchtypicalchangesinheadMRIenhancedimagingisbeneficialtoclinicaldiagnosis.[Keywords]pachymeningitis;pathology,clinical;imaging肥厚性硬脑膜炎(hypertrophiccranialpachymeningitis,HCP)是中枢神经系统一种较为少见的疾病,由Charcot等(1869年)首先描述,通常涉及硬脑膜、小脑幕和大脑镰,表现为头痛、进行性颅神经麻痹、小脑性共济失调等[1-2]。近几年国内对该病逐渐认识并陆续见病例报道。2006年2月至2009年12月我院收治5例HCP,现结合近年来国内外文献探讨该病的病因、病理、临床表现和影像学特点。1临床资料本组5例,男4...