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1、·332·中华神经科杂志2001年12月第34卷第6期 ChinJNeurol,December2001,Vol34,No.6·论著·脑干脑炎15例临床分析王坚 汪寅 赵重波 吴洵轶 蒋雨平 【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
2、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3919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。【关键词】 脑炎; 脑干; 预后Brainstemencephalitis:clin
3、icalanalysisof15casesWANGJian,WANGYin,ZHAOChongbo,etal1DepartmentofNeurology,HuashanHospitalAffiliatedtoMedicalCenterofFudanUniversity,Shanghai200040,China【Abstract】 ObjectiveToinvestigatetheclinical,neuroimaging,pathologicalfeaturesandprognosisofbrainstemence
4、phalitis1MethodsTheclinicalandneuroimagingfeaturesandprognosisof15caseswithbrainstemencephalitiswereanalyzedretrospectively1Amongthem,1caseofbrainautopsywasstudiedbyHE,K2Bandimmunohistochemicalstaining1ResultsIn7cases,thehistoryofviralinfectionsbeforetheonseto
5、fdiseasewasobtained1Theinitialneurologicalmanifestationwasdizzyin6cases,diplopia,headacheandvomitingin2casesrespectively,andunconciousness,ptosisandfacialnumbnessin1caserespectively1Themainclinicalfeatureswereshownthat15casesdemonstratedtheinvolvementofcranial
6、nerves,9casespyramidaltractand5casesspinothalamictract,8casesataxia,4casesHornersignand2casesunconsciousness1MRIfoundsingleormultiplelesionsinthecorrespondingpartsofbrainstemin10cases1Incaseofbrainautopsy,neuropathologicalexaminationrevealedlocalhemorrhagicnec
7、rotizingsofteninglesionsinthepontinetegmentumandlateralmedulla1Amarkedinfiltrationoflymphocyticinflammatorycellsandmacrophageswereobservedinthenecroticarea1Myelinloss,axonalswellingandmildincreaseofreactiveastrocyteswerealsoobservedinthecranialnervenuclei1Ther
8、ewasnopositivefindingofimmunohistochemicalstainingbyusingtheprimaryantibodiesagainstHSV2I,Ⅱ,EB,CMVandtoxoplasma1Theprognosisforothersurviving14caseswerebenign,andnorelapsingcasewas
