摘要
目的 探讨脑干脑炎的临床特点、影像学、病理改变及预后。方法 对 15例脑干脑炎的临床特点、影像学及预后作一回顾性分析 ,其中 1例死亡者行脑局部解剖及组织学检查。 结果7例出现以上呼吸道感染为主的前驱症状。首发症状头晕 6例 ;复视、头痛、呕吐各 2例 ;意识不清、眼睑下垂、面部麻木各 1例。全部患者均有颅神经损害 ,9例锥体束和 5例感觉长束征 ,8例小脑征 ,4例Horner征 ,2例昏迷。MRI显示 10例在脑干内相应部位有异常病灶。尸检病例显示病灶位于脑桥至延髓锥体交叉处 ,中心部呈灶性坏死和片状出血 ,大片髓鞘脱失、轴索肿大伴弥漫性淋巴细胞和组织细胞浸润。应用抗单纯疱疹病毒Ⅰ、Ⅱ型 ,EB病毒 ,巨细胞病毒和弓形体抗体的免疫组织化学染色均阴性。存活的 14例预后良好 ,平均随访 39 9个月无复发。结论 脑干脑炎多呈单相良性病程 ,并非多发性硬化的首次发作。病原学常难以明确。
Objective To investigate the clinical,neuroimaging, pathological features and prognosis of brainstem encephalitis. Methods The clinical and neuroimaging features and prognosis of 15 cases with brainstem encephalitis were analyzed retrospectively.Among them,1 case of brain autopsy was studied by HE,K-B and immunohistochemical staining. Results In 7 cases,the history of viral infections before the onset of disease was obtained.The initial neurological manifestation was dizzy in 6 cases,diplopia,headache and vomiting in 2 cases respectively,and unconciousness,ptosis and facial numbness in 1 case respectively.The main clinical features were shown that 15 cases demonstrated the involvement of cranial nerves,9 cases pyramidal tract and 5 cases spinothalamic tract,8 cases ataxia,4 cases Horner sign and 2 cases unconsciousness.MRI found single or multiple lesions in the corresponding parts of brainstem in 10 cases.In case of brain autopsy,neuropathological examination revealed local hemorrhagic necrotizing softening lesions in the pontine tegmentum and lateral medulla.A marked infiltration of lymphocytic inflammatory cells and macrophages were observed in the necrotic area.Myelin loss,axonal swelling and mild increase of reactive astrocytes were also observed in the cranial nerve nuclei.There was no positive finding of immunohistochemical staining by using the primary antibodies against HSV-I,Ⅱ,EB,CMV and toxoplasma.The prognosis for other surviving 14 cases were benign,and no relapsing case was found after 39.9 months of follow-up. Conclusions The course of brainstem encephalitis seems to be monophasic and benign,which indicates that it might be not the first episode of multiple sclerosis.The underlying causes of the disease are usually difficult to be identified.
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2001年第6期332-334,共3页
Chinese Journal of Neurology
关键词
脑干
脑炎
预后
病理
Encephalitis
Brain stem
Prognosis
