脑囊虫病诊断方法的探讨

为进一步探讨脑囊虫病的诊断方法,对４３例具有中枢神经系统症状和体征的病人进行了脑部ＣＴ、血清和ＣＳＦ囊虫抗体检查（ＥＬＩＳＡ）,３２例ＣＴ无典型脑囊虫病改变的患者做了脑ＭＲＩ检查。结果１１例（２５．６％）ＣＴ表现为多发圆形低密度灶,部分间有点状钙化,为脑囊虫病的典型改变,余３２例改变不典型或无异改变。血清囊虫抗体阳性３７例（８６．０％）,ＣＳＦ囊虫抗体阳性３２例（７４．０％）。２７例（８４．４％）     

脑囊虫病各病期囊虫抗体变化及意义

用ＥＬＩＳＡ方法检测３６例经头颅ＣＴ或ＭＲＩ检查诊断的脑囊虫病患者血及脑脊液中囊虫抗体，发现在脑囊虫各不同病期，囊虫抗体阳性率存在极显著差异（Ｐ＜０．００５），以活动期及有存活囊尾蚴为主的混合期抗体阳性率高。在一定程度上对临床选择正确治疗方案提供帮助。     

脑囊虫病若干CT表现的探讨

脑囊虫病可因其数目、部位、病期等不同而有多种多样的CT表现,现将一些较少见、或与手术有关的、尚有争论的CT表现分述并讨论如下。     

脑囊虫病的MRI分期及临床意义

目的探讨脑囊虫病ＭＲＩ分期及分型的临床意义。方法对９０例脑囊虫病人的ＭＲＩ进行分析。结果将ＭＲＩ所见分为活囊虫期、变性水肿期、死亡期和混合期，每期又分为若干型。结论掌握各期特点对于临床监测、治疗评估及进一步深入研究均具有重要意义     

脑囊虫病的临床、头颅CT、MRI(附70例报告)

现我院 1974年 3月～ 2 0 0 0年 1月间收治并确诊的脑囊虫病 70例进行分析 ,并结合复习文献讨论如下 [1～ 3] :临床资料一、一般资料 :70例全部符合脑囊虫病诊断标准 [1 ] ,其中男 5 8岁 ,女 12例 ,年龄 6～ 6 2岁 ,平均年龄 31.7±岁 ,以青壮年男性最多占 46例 6 5 .7%。病程最短 2小时 ,最长 17年 ,平均 1.4年 ;有食用或接触米猪肉患者 10例 ,有牧区生活史并接触牛羊史者 7例 ,有肠绦虫病史者 9例。二、临床表现 :以癫痫发作表现者最多占 47(6 7% )例 ,其中全身强直—阵挛发作 2 4(34 % )例 ;单纯部分性发作 6(8.6 % )例 ;复杂部分性发作 …     

高颅压型脑囊虫病诊断和治疗的探讨

高颅压型脑囊虫病诊断和治疗的探讨朱士兴，刘玉亭脑囊虫病在我国的北方和南方目前均较为常见，有高颅压的脑囊虫病误诊率较高，而且因其病情严重，有突然恶化的危险，治疗上是一个棘手的问题。现就我们诊断和治疗的５４例高颅压型脑囊虫病报告如下。临床资料一般资料：男...     

脑囊虫病的临床与脑电图、CT改变的研究

脑囊虫病的临床表现复杂多变 ,目前国内外对其的分型种类较多 ,各有不同侧重。现将我院近几年收治的 6 5例脑囊虫病患者的临床、脑电图、CT等资料结合分型分析如下 :1　临床资料患者 6 5例 ,男 37例 ,女 2 5例 ,男女之比为 1∶ 0 .76 ,年龄 7～ 72岁 ,平均 43岁。临床分癫痫型 33例 ,高颅压型 18例 ,混合型 14例。全部患者均经脑电图、CT、免疫学检查 ,结合临床病史、腰穿确诊 ,符合 1986年制定的脑囊虫病诊断标准 [1 ]。6 5例患者中脑电图异常 49例 (75 % ) ,其中界限异常 8例 ,轻度异常 2 5例 ,中度异常 12例 ,重度异常 2例。癫痫型患者…     

脑囊虫病治疗方法探讨

目的研究各种不同类型脑囊虫病的最佳个体化治疗方案。方法回顾性分析作者医院2002-01—2008—12收治的脑囊虫病确诊病例共42例,其中脑实质型32例、脑室型8例、蛛网膜下型2例。根据脑囊虫病分型选择驱虫、脱水、糖皮质激素抗炎、手术切除囊虫或脑室引流等不同的治疗方法,观察疗效并探讨各种类型脑囊虫病的最佳治疗方案。结果所有患者均取得较好疗效。治疗过程中曾出现颅高压或颅高压加重11例,经过将脱水药加量或改变治疗方案后其症状均获缓解。结论对脑囊虫病必须根据患者的具体情况采取不同的个体化治疗方法。     

脑囊虫病37例临床及影像学特点分析

目的:探讨脑囊虫病的临床及影像学特点,以利于其与颅内其他炎性或肿瘤性病变鉴别。方法:对1995～ 2004年收住我院的37例脑囊虫病的临床及影像学资料,进行回顾性研究。结果:37例脑囊虫病患者,男性25例,女性 12例,年龄6～62岁,平均28岁。经病理证实34例,脑脊液及血清免疫学检查支持3例。临床表现以癫痫样发作为主 者18例(48．6％),以头痛、呕吐、视乳头水肿等颅内压增高为主要表现11例(29．7％),以肢体活动障碍为主者3例(8． 1％),以阵发性眩晕、恶心、呕吐为主者5例(13．5％),头痛伴癫痫发作者4例,头痛伴视力下降者2例,29例无神经系统 阳性体征(80％)。按病变部位并结合影像加以分型:脑实质型27例,脑室型3例,脑膜型5例,混合型2例。结论:单纯 根据临床症候难以确定脑囊虫病,结合MRI观察病灶内是否有头节、病灶囊内密度、囊壁信号等细微变化,同时注意 DWI及增强扫描表现,大多数患者可以得到诊断,少数需应积极进行脑活检。     

脑囊虫病有效药物治疗:吡喹酮

目的:研究脑囊虫病的临床特点及有效的治疗措施。方法:对495例脑囊虫病患者进行回顾性研究,总结其临床特征,实验室检查数据,影像学指标及治疗方法。结果:495例脑囊虫病患者中59.2%为男性,40.8%为女性;82.0%为农村人口,18.0%为城市人口。患者中癫痫发作340例,头痛171例。血液和脑脊液免疫检查囊虫阳性率分别为67.8%和46.9%。CT和MRI检查显示,患者中包括了四种类型脑囊虫病。其中437例给予吡喹酮治疗,41例手术治疗。23.7%患者痊愈;71.5%患者临床症状明显改善。结论:脑囊虫病流行趋势农村高于城市,癫痫发作和颅压升高为主要临床症状。绝大多数患者应用吡喹酮有效。     

Diffuse cerebral cysticercosis: clinical and CT findings in a case

A case of cerebral cysticercosis with both generalized and partial (multifocal) seizures is described. The diagnosis was not possible with traditional (pre-CT) procedures, but CT disclosed a very characteristic pattern. This disease, rare in our country, is very common elsewhere, particularly in South America, where epilepsy of recent onset in an adult or symptoms of increased intracranial pressure always suggest this possible etiology.

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Sommario Viene descritto un caso di cisticercosi cerebrale, le cui manifestazioni cliniche consistevano in crisi epilettiche generalizzate o parziali (multifocali). La diagnosi, non evidente con i metodi neuroradiologici tradizionali (pre-TC), è stata chiarita dalla TC che ha dimostrato un quadro assai caratteristico. Viene sottolineato che quest'affezione, rara nel nostro paese, è invece assai frequente in diverse zone del mondo, in particolare nel Sud America, ove l'insorgere di un'epilessia in un adulto o di una sindrome di ipertensione endocranica deve far sempre pensare a questa eziologia.

     

Natural history of solitary cerebral cysticercosis cases after albendazole therapy: a longitudinal follow‐up study from India

Goel D, Mittal M, Bansal KK, Singhal A. Natural history of solitary cerebral cysticercosis cases after albendazole therapy: a longitudinal follow‐up study from India.
Acta Neurol Scand: 2010: 121: 204–208.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives – To find out natural course of solitary cerebral cysticercosis (SCC) cases after treating them with 2 weeks albendazole therapy. Material and methods – All patients with SCC were treated with 2 weeks of albendazole therapy with follow‐up radiological scan at 6 months and 2 years. The evolution of lesion was noted as complete resolution, calcification or persistent active. Antiepileptic drugs (AED) prophylaxis was given for 1 year in patients with complete resolution and for 2 years in calcified lesion, respectively. AED was continued in persistent lesion group till it became calcified or resoluted completely. One‐year follow‐up was done in all after stopping AED. Results – Among 345 cases, 226 (65.5%) had complete resolution with very low seizure relapse rate with 1 year of seizure free period on AED treatment. On the contrary, 105 (30.5%) had calcified lesion with high seizure relapse rate after stopping AED treatment with 2 years of seizure free period. Fourteen patients (4%) could not stop their antiepileptic medication at all because of active lesion. Conclusion – Two‐third of patients with SCC have favorable outcome with complete resolution and needs short‐term AED prophylaxis and the rest one‐third requires long AED treatment to prevent seizures.     

脑囊虫病53例临床分析

脑囊虫病是中枢神经系统最常见的寄生虫感染性疾病，临床表现复杂多样，目前尚无统一分型标准，且治疗方案不统一，疗程长短不一，疗效判断标准不一。为了对本病的临床特点有更多认识，现就我院2000年1月～2005年12月收治的53例脑囊虫病患者的临床特点作如下分析。     

Microsurgical management of cerebral parenchymal cysticercosis

Objective

Microsurgery is an optional way to treat parenchymal neurocysticercosis. The aim of this study is to evaluate the therapeutic efficacy of microsurgery in cerebral parenchymal cysticercosis.

Materials and methods

A retrospective analysis was performed of the clinical data and outcomes of microsurgery in 20 cases of cerebral parenchymal cysticercosis.

Results

All head segments found in cysticercus cysts were removed completely. Total resection of the cystic wall was achieved in 16 cases and subtotal resection in 4 cases. Twelve patients recovered from intracranial hypertension soon after the operation. No novel complications or deaths occurred postoperatively. The patients were followed up for 3 months to 10 years; among them, 14 patients who had epilepsy before surgery were markedly improved and controlled, 4 of 5 patients recovered from hemiparesis within 6 months after surgery, and 2 patients with cerebellar ataxia showed improvement. Two patients were lost to follow-up.

Conclusions

Despite a high rate of misdiagnosis of cerebral parenchymal cysticercosis, microsurgery is associated with satisfactory clinical outcomes in appropriately selected patients.     

脑室内猪囊虫病的CT和MR影像学诊断

报告经手术和病理证实的脑室内猪囊虫病３７例。ＣＴ轴位扫描均表现为脑室不对称性扩大，以囊虫所在的脑室扩大最为明显；增强扫描４例均无强化病灶；Ｉｓｏｖｉｓｔ脑室造影ＣＴ扫描２８例，２７例见脑室内球形低密度充盈缺损，１例导水管以上无占位性病变，导水管以下无造影剂。２例改变体位后复查ＣＴ扫描，充盈缺损病灶位置有改变。３例ＭＲ均表现为第四脑室扩大特别显著，第三脑室和双侧侧脑室扩大。对脑室内猪囊虫病的ＣＴ和ＭＲ影像学特点进行了讨论。     

脑囊虫病患者的智力、记忆力和情感的研究

本文对９３例脑囊虫病患者进行了情感测验，其中４３例进行了记忆测验，４０例进行了智力测验。分别与正常人对照组相比，脑囊虫病可造成患者的记忆、智力水平明显下降（Ｐ＜０．００１：Ｐ＜０．０５）；并给患者造成了明显的焦虑和抑郁情感（Ｐ＜０．００１），女性病人的情感更易受影响，男性病人中伴发癫痫或高颅压者的焦虑成绩均明显高于无相应指标者。     

脑囊虫病人血清、脑脊液中抗体在MRI各期的变化

目的 检测脑囊虫病人血清和脑脊液中抗体在MRI各期的变化。方法 用抑制性ELISA法检测血清及脑脊液中的抗体。同时根据MRI表现将病例分为活动期、退变期、非活动期。结果 在69个病例中，脑脊液中抗体阳性率分别是：活动期75．00％，退变期62．50％，非活动期17.24％；血清中是81．25％、16．67％、22．22％。在相应各期中，脑脊液和血清抗体阳性率无显著性差别。结论 在影像学的不同时期抗体阳性率存在明显的变化。     

641例脑囊虫病致癫痫临床分析

目的 探讨脑囊虫病致癫痫的临床特点及治疗方法。方法 通过对641例脑囊虫病致癫痫患者的回顾性分析，总结其临床特点、免疫水平、影像学及脑电图资料和治疗方法。结果 脑囊虫病致癫痫男性患者占78．47％，女性患者占21．53％，发作频率平均每年2—4次，发作类型以全身强直—阵挛发作(GTC)多见，囊虫免疫反应血IHA及血ELISA均为71．92％，脑脊液CAg阳性率78．40％，脑电图无特异性改变，影像学显示有各种类型脑囊虫病，胞二磷胆碱辅助治疗较用复方丹参更易诱发癫痫(P＜0．01)。结论 脑囊虫病致癫痫男性多于女性，发作频率不高，发作类型多样，免疫力低下，各种类型脑囊虫病均可导致癫痫，脑囊虫病辅助治疗慎用促脑代谢药物。