以头痛为主要症状的囊尾蚴病8例临床分析

目的：通过研究囊尾蚴病的流行病学和临床特征，加强临床工作者对囊尾蚴病的认识，提高临床诊治水平。方法：回顾性分析2009年1月—2015年12月于南京医科大学第一附属医院住院治疗的8例以头痛为主要症状并确诊为囊尾蚴病患者的流行病学资料、临床表现、辅助检查结果、诊断、治疗与转归等。结果：8例囊虫病患者中，男5例、女3例，年龄23～54岁，平均年龄40岁；汉族7例，侗族1例；3例有喜食生肉、涮火锅等爱好，其余5例无明确流行病学史。临床表现方面，7例为脑囊尾蚴病，1例为混合型囊尾蚴病（脑型合并皮下及肌肉型）；5例以头痛伴或不伴恶心、呕吐为首发症状，2例以头痛伴癫痫为首发症状，1例以头痛伴上肢不利为首发症状。3例患者白细胞轻度升高，2例轻度贫血，嗜酸性粒细胞计数均在正常范围内。5例患者行脑脊液检查，3例蛋白含量升高，2例细胞数轻至中度升高，且以淋巴细胞增多为主。7例患者行血清囊尾蚴特异性抗体检测，有4例阳性。5例患者行头颅CT，仅1例影像学初步诊断时考虑脑囊虫病可能；8例患者均行头颅MRI，有4例影像学初步诊断时考虑寄生虫或囊虫病可能。3例患者予以吡喹酮，1例予以口服吡喹酮及槟榔南瓜子，2例予以阿苯达唑抗虫治疗，2例行脑室—腹腔分流术并予以吡喹酮抗虫治疗。结论：非流行区医务工作者对于无法用常见病解释的头痛、癫痫患者应警惕囊尾蚴病可能。

Clinical features of cysticercosis with initial complaints of headaches: a retrospective analysis of 8 cases.

Objective To investigate the epidemiological and clinical features of cysticercosis with initial complaints of headaches. Methods The epidemiological data, clinical manifestations, laboratory and image examination results, diagnosis and treatment of eight patients with cysticercosis who presented with headaches as initial complaints form January 2009 to December 2015 in the First Affiliated Hospital with Nanjing Medical University were retrospectively analyzed. Results A total of 8 hospitalized cases was investigated, 5 cases were male and 3 cases were females, the median age was 40yrs. 7 cases belonged to the Han nationality, the other one was Dong nationality. Among these 8 cases, 3 liked to eat raw meat or chafing dish. 7 cases were cerebral cysticercosis, 1 case was cerebralaccompanied with subcutaneous and intramuscular cysticercosis. 5 cases presented with headache with or without nausea and vomiting as the initial complaints, 2 cases presented with headache and epilepsy, 1 case presented with headache and upper limb dyskinesia. The complete blood count implied the presence of slight leukocytosis in 3 cases as well as insignificantly lowered hemoglobin values in 2 cases, with a normal eosinophile granulocyte value in all patients. Of the 5 patients who underwent cerebrospinal fluid examinations, the protein content increased in 3 cases, the number of cells increased from mild to moderate and mainly with increased lymphocytes in 2 cases. 4 of 8cases who accepted test of serum specific antibodies againstcysticercus were positive. The initial imaging diagnosis took cysticercosis into account in only one case of5 patients whounderwent cranial CT scan, in 4 cases of all 8patients whounderwent cranial MRI. 3 cases received praziquantel, 1case received praziquantel and areca and cucurbitae semina, 2 cases received albendazole, 2 cases underwentventriculo-peritoneal shunt and then received praziquantel. Conclusions Clinical medical staff in non-epidemic areas should consider cysticercosis when met with headache or epilepsy which can not be explained by common diseases.