精神行为异常 肢体抽搐5个月

正病例摘要患者女性,17岁,因精神行为异常、反复肢体抽搐5个月,于2016年5月13日入院。患者于入院前5个月(2015年12月5日)出现鼻塞、流涕;3 d后(12月8日)出现发热,体温最高达38℃,随后出现幻听、失眠;2 d后(12月10日)出现言语不清,对答欠合理,伴双手不自主抖动,无下肢不自主运动,无乏力、肌肉疼痛,无头痛、恶心、呕吐,无意识障碍;无大小便失禁,于2015年12月11日入当地医院住院治疗。腰椎     

发热 头痛 右侧肢体无力 言语含糊

病历摘要患者男性,27岁。主因头痛4个月,发热、右侧肢体无力2个月,言语含糊5d,于2011年5月21日入院。患者于入院前4个月(2011年1月)无诱因出现头痛,不伴发热,不影响日常工作。外院行头部CT检查无异常发现,亦未予以治疗;1个月后(2011年2月底)头痛症状加剧,伴非喷射性呕吐,且间断出现发作性左侧肢体麻木、无力,每次持续约15min(2011年3月初);发病后2个月时(2011年3月底)间断出现视物成双,外院MRI增强扫描(2011年3月28日)显示双侧额上回、小脑半球异常信号,局部软脑膜异常强化(图     

发热、头痛、癫癎样发作

病历摘要患者男,19岁。因发热、头痛5d,左眶周红肿2d,言语不能,伴左侧肢体乏力1 d于2003年11月13日入院。入院前5d无诱因出现畏寒、发热、头痛,体温高达40℃,伴乏力、头昏、食欲下降,自认为是感冒,服感冒药及口服青霉素后症状无好转;入院前2d出现左眼眶红肿;1 d前出现语言障碍     

发热、头痛、癫痫样发作

病历摘要患者男,19岁。因发热、头痛5d,左眶周红肿2d,言语不能,伴左侧肢体乏力1 d于2003年11月13日入院。入院前5d无诱因出现畏寒、发热、头痛,体温高达40℃,伴乏力、头昏、食欲下降,自认为是感冒,服感冒药及口服青霉素后症状无好转;入院前2d出现左眼眶红肿;1 d前出现语言障碍     

急性酒精中毒伴迟发性脑病一例

临床资料患者,男,38岁,主因走路缓慢1周,加重伴反应迟钝4d于201 1年3月2日入院.患者于入院前1周无明显诱因出现行走明显减缓,无言语障碍,无头痛、头晕及复视,无意识障碍及抽搐,无发热,间断出现情绪波动,于入院前4d上述症状较前加重并同时出现反应明显迟钝,记忆力下降,伴有明显的时间及地点定向力障碍.于我院查头CT(图1)示双侧侧脑室白质密度减低.头MRI(图2)示双侧半卵圆中心、脑室旁白质异常信号影.     

可逆性后部白质脑病合并丘脑新发梗死一例

正患者男性,52岁,主因头痛、头晕伴左侧肢体麻木无力1d于2015年3月6日20时入院。患者当天早10时无明显诱因出现头痛、头晕,伴左侧肢体麻木无力,以左下肢为著,无恶心、呕吐,无意识障碍及肢体抽搐,无饮水呛咳及吞咽困难,查头颅CT(图A)示:脑干稍低密度灶。以"脑血管病"收入神经内科。既往高血压史6年,最高血压达240/160mm Hg     

抗N-甲基-D-天冬氨酸受体脑炎合并畸胎瘤二例

正例1女性,28岁,因头痛、发热7 d,精神异常5 d,进行性加重,伴间断性抽搐发作1 d,于2015年4月25日入河北省人民医院。患者7 d前出现发热、感冒,体温最高达39.6℃,伴头痛、恶心、呕吐,无头晕,外院头部CT和脑电图检查均未见明显异常,临床高度怀疑"病毒性脑炎",予抗病毒治疗(具体方案不详)后头痛症状好转,仍有低热(37.6℃)。5 d前间断出现幻觉、错觉,持续约10 min后自行缓解,     

脑干脑炎恢复期伴发急性脊髓炎一例

临床资料患者女性,57岁,因"头痛10d,发热、疱疹5d,伴意识障碍1d"于2010年10月17日入院.入院10d前患者无明显诱因出现头痛,呈持续性,伴恶心、呕吐,5d前出现发热,最高达38.5℃,右侧眼睑及前额出现疱疹,在当地医院应用"阿昔洛韦"等药物治疗,1d前出现烦躁、胡言乱语、嗜睡.既往"高血压病"病史.体检:体温36.6℃,心率108次/min,呼吸21次/min,血压90/70mmHg(1mmHg=0.133kPa),右侧眼睑及前额可见疱疹,右侧结膜红肿、充血.心、肺、腹无异常.     

丙戊酸钠脑病一例报告

患儿男，5岁8个月。因间断抽搐2个月，加重4d于2004年5月13日入院。于2004年3月11日开始出现阵发性抽搐，发作时意识不清，口吐白沫，四肢强直，持续5～15min可缓解，不伴发热，无头痛、呕吐表现，无精神障碍及性格行为改变，1周内抽搐4次。脑电图检查显示高幅复形慢波及阵发性尖节律，诊断为癫痫。口服丙戊酸钠(VPA)片0．2g，3次／d，5d后症状控制，此后坚持服药未再抽搐。4d前突然出现共济失调、意识障碍，抽搐发作频繁。     

新隐球菌性脑膜炎合并败血症致顽固性低血糖症一例报告

患者 男性，33岁。主诉头痛、呕吐5d，发热1d，于2007年8月15日入院。患者于入院前5d突发头痛，以额部及双侧颞部明显，呈持续性胀痛，伴恶心、呕吐，呕吐物为胃内容物，非喷射状；入院前1d发热，最高体温为38．5℃，症状无缓解。患者为乙肝病毒携带者。     

Clinical signs and serial MRI in Listeria Rhombencephalitis: a case report

A case of Listeria Rhombencephalitis in a 63-year-old-man under corticosteroid treatment for suspected rheumatoid arthritis is described. The diagnosis was based on the clinical signs, cerebrospinal fluid findings, blood culture and MRI. Radiological and clinical correlation, clinical aspects and therapeutical problems are discussed.     

单核细胞增生性李斯特菌脑膜炎免疫应答机制的研究进展

李斯特菌脑膜炎是单核细胞增生性李斯特菌感染引起的脑膜炎，具有极高的致死率。对李斯特菌病的发病机制的研究目前主要集中在细菌如何跨肠道屏障、胎盘屏障方面。而免疫学机制及炎症通路有待表征。研究发现在感染早期宿主就能识别细菌DNA启动先天性免疫反应，随后引起相应靶细胞分泌炎症因子启动适应性免疫反应。该文从固有性免疫、适应性免疫反应、补体系统等方面综述了单核细胞增生性李斯特脑膜炎发病机制的研究进展。     

Listeria rhombencephalitis: report of two cases with early diagnosis and favourable outcome

We present 2 cases of Listeria monocytogenes rhombencephalitis (L-RE), both affecting previously healthy adult men. Each of them developed a diphasic syndrome first characterized by fever, nausea and headache, followed, in a second phase, by severe brain stem dysfunction at the level of the pons, with meningism, multiple cranial nerve palsies, ataxia, and, in one case, seizures. The early examination of the cerebrospinal fluid (CSF) demonstrated the presence of Gram-positive bacilli whose typical characteristics were compatible with those of Listeria, allowing for immediate administration of a specific therapy. Neuroimaging techniques (either CT or MRI) did not provide any evidence of brain stem involvement, and they did not positively contribute to the diagnostic process. The immediate use of a specific antibiotic therapy led to a favourable clinical outcome for both patients.     

Listeria monocytogenes brainstem infection (rhombencephalitis) mimicking ischemic stroke

The frequency of Listeria monocytogenes (Lm) infection of the central nervous system is increasing. We report a patient recently treated with chemotherapeutic drugs for pulmonary adenocarcinoma who suddenly developed hemiparesis, was initially diagnosed with stroke, and was then found to be affected by Lm rhombencephalitis accompanied by a brain abscess. Lm meningoencephalitis mimicking ischemic stroke is rare but must be considered, especially in specific patients.     

Microglial activation and expression of immune‐related genes in a rat ex vivo nervous system model after infection with Listeria monocytogenes

A wide variety of microorganisms has previously been identified as causes of brain infection. Among them, Listeria monocytogenes has a particular tropism for the central nervous system. To gain knowledge about the immune response elicited by L. monocytogenes in the brain, we used a rat ex vivo organotypic nervous system culture as a model for Listeria infection. Scanning electron microscopy (SEM) revealed that activated microglial cells showing a typical amoeboid morphology are quickly recruited to the surface of the explants after the infection. After bacterial engulfment, these cells appear to act as Trojan horses, releasing the engulfed bacteria inside the brain tissue. We describe cycles of microglial phagocytosis, necrotic cell death and the subsequent removal of cell debris for the first time. Furthermore, we used this ex vivo model to assess the expression profiles of immune relevant genes up to 24 h postinfection by means of q‐PCR‐arrays, finding that a number of inflammation‐promoting genes are upregulated. Shortly after infection by L. monocytogenes, upregulated genes were those that encoded molecules involved in Th1 responses, being the Ccl2 chemokine and members of the interleukin1‐β family the most abundant immunomodulatory signals expressed. After 5 h of infection, L. monocytogenes caused a substantial increase in the expression of TLR1 and TLR2 genes, as well as in several downstream genes of the TLR signaling pathways. © 2013 Wiley Periodicals, Inc.     

Syringomyelia following <Emphasis Type="Italic">Listeria</Emphasis> meningoencephalitis: report of a case

A case of symptomatic syringomyelia which appeared six years after Listeria meningoencephalitis is described. Chronic spinal arachnoiditis, as shown by standard MRI and dynamic phase contrast (PC) cine-MRI, may occur after spinal infection and is likely the cause of syringomyelia. To our knowledge, there are no previous reports of delayed spinal complications following Listeria monocytogenes infection. The possibility of developing syringomyelia should be always considered in any patient with a history of central nervous system infection. Received: 12 September 2002 / Accepted in revised form: 30 January 2003 Correspondence to: R. Nardone     

Early symptoms and outcome ofListeria monocytogenes rhombencephalitis: 14 adult cases

Listeria monocytogenes rhombencephalitis has never been studied in a significant group of patients. We describe 14 adult cases who were seen over a 10-year period. A biphasic illness was characteristic: (1) prodromes (5–15 days) with malaise, fatigue, headache, nausea or vomiting, and fever; (2) cranial nerve palsy with facial palsy, diplopia, dysphagia, dysarthria, usually multiple. Meningism and hemi- or tetraparesis were present in 11 patients and cerebellar dysfunction in 9 patients. In 4 cases, CT showed widening of the brain stem with disappearance of the surrounding cisterns. The cerebrospinal fluid was abnormal in all patients in whom this investigation was done (pleocytosis, elevation in protein content). The patients received antibiotic therapy for 2–6 weeks. In the 9 patients who recovered, the neurological dysfunction improved within 2 days to 1 week of the initiation of therapy. There were 5 deaths. At autopsy in 2 cases, there was severe purulent meningitis and rhombencephalitis with predominantly polymorphonuclear cellular infiltration in 1 case, while numerous microabscesses in the midbrain, pons and medulla were observed in the other. We conclude thatL. monocytogenes infection should be considered in patients who develop fever and focal neurological signs particularly localized to the brain stem.     

Intramedullary brain stem cyst and trapped IV ventricle after infection with Listeria monocytogenes

We present the rare case of a girl surviving intrauterine listeria brain stem meningoencephalitis, who subsequently developed hydrocephalus, a trapped IV ventricle and an intramedullary cyst. Such cases have been reported only infrequently, and in earlier cases modern imaging studies were not available. Magnetic resonance imaging has been helpful in our patient to delineate the lesions and plan further treatment. Received: 21 January 1998