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广州管圆线虫致嗜酸细胞性脑脊膜神经根炎
http://www.100md.com 《中华神经科杂志》 1999年第6期
管圆线虫|广州||管圆线虫目感染|神经根炎,关键词:
     陈秀芸 黄向东 曾世斌 浙江省温州市第二人民医院神经内科 325000 中华神经科杂志 1999 0 32 6


    关键词:管圆线虫;广州;;管圆线虫目感染;神经根炎 期刊 zhsjkzz 0 论著摘要 fur -->


    

摘要 目的 报道10例广州管圆线虫引起的嗜酸细胞性脑脊膜神经根炎,以期提高对该病的认识和重视。方法 对10例患者的临床全过程及实验室检查进行系统的观察及随访,并结合当地流行病学资料及国内外文献,实行对比研究。结果 该组病例具有如下特征:①急性起病(10例);②剧烈头痛(10例)和(或)躯体痛性感觉障碍(8例),伴发热(8例)、全身违和(10例);③可有脑神经(3例)或脊神经根(8例)受累;④无明显颈抵抗及病理征(10例);⑤脑脊液(6例)及外周血(10例)中嗜酸细胞数增高;⑥血清和脑脊液广州管圆线虫蚴抗体均呈阳性(5/5例);⑦病程自限,预后良好(10例);⑧病前食用过生淡水螺肉(8例);⑨所在地为广州管圆线虫新疫源地;⑩已排除其他蠕虫感染。结论 一度在温州暴发流行的一种“怪病”实属广州管圆线虫所致的嗜酸细胞性脑脊膜神经根炎。

Eosinophilicmeningoradiculitis caused by Angiostrongylus cantonensis

CHEN Xiuyun, HUANG Xiangdong, ZENG Shibin.

    Department of Neurology, Wenzhou No.2 Hospital, Wenzhou 325000

Abstract Objective To report ten cases of eosinophilic meningoradiculitiscaused by Angiostrongylus cantonensis which should be well recognized and paid moreattention to. Methods The ten cases consisted of six inpatients and four outpatients ofour hospital, including 6 females and 4 males. Their ages were 24-48 years with an averageof 33.5 years. The whole clinical courses and laboratory data of the patients weresystematically observed and followed up with epidemiological investigation for half ayear. The previous reports were also studied as the controls. Results The clinical manifestations ofthe ten patients comprised: acute onset (10/10), severe headache (10/10), painfulparesthesia (8/10), fever (8/10) and malaise (10/10). Headache was the most prominentsymptom occurring usually in intermittent attacks, the common sites being located in theoccipital, frontal and bitemporal regions. Body paresthesia were expressed as severe skinpain exacerbated by the slightest touch (8/10), numbness (2/10), itching (2/10) andsensation like worms crawling on the skin (1/10). Occasionally diplopia (2/10) and facialparalysis (1/10) might be developed. Signs of the central nervous system such as neckstiffness and kernigs sign were not evident. Tendon reflexes might be decreased (5/10) orincreased (2/10). Pathologic reflexes (10/10) were not demonstrated. Laboratory findingswere as follows: (1) Hemogram showed WBC count to be (8.5-12.5)×109 /L andEosinophilic count to be 0.08~ 0.21. (2) The CSF became slight cloudy in gross appearance and theCSF pressures were found to be 1.67~ 2.25 kPa. WBC count in the CSF was (470~ 1 100) ×106 /L, Eosinophillic was 0.08~ 0.60 and protein was 0.73~ 1.44 g/L. Both glucose andchloride were normal. Detection of the antibodies of A.Cantonensis by ELISA method in CSFand sera of 5 cases were all positive (5/5). No parasite was recovered. The bacteriacultures were negative. (3) Mild abnormalities on the EEG were found in eight cases andmoderate abnormalities were seen on the EEG in only one case. (4) Of 2 cases, the commonperoneal nerve and tibial nerve showed sensory conducting velocities (SCV) decreased. (5)No abnormality was found on imaging scanning. The clinical course was 28~ 60 days with an average of 36.4days. No relapse or obvious sequaela was found after half a year of following up.Epidemiologic investigation demonstrated that 8 cases had a history of eating uncookedfresh water snails, Ampullaria gigas, before the onset. One patient had eaten uncookedshrimps and the remained did not remember what had been eaten in the past. Wenzhou as anew endemic area of A.cantonensis had been established recently and other larva migranshad been ruled out. As a whole, the above mentioned clinical characteristics werecompatible with A.cantonensis previously reported at domestically and abroad. Conclusion The “ strange disease” of outbreak in Wenzhou is actually eosinophilicmeningoradiculitis caused by A.cantonensis.

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