肥厚性硬脑膜炎一例

摘要

Objective To report a case of HCP in order to raise some awareness of the disease and decresed further misdiagnoses.Methods Through the more comprehensive serum and cerebrospinal fluid laboratory test, imaging findings (CT, MRI, SPET) and dural biopsy, the medical records were done.The differential diagnosis, steroid treatment responses and a 1-year follow-up results were analyzed and summarized.Results A male patient, 61 years., was admitted for mainly two and a half months dizziness, tinnitus, dysphagia, hoarseness,accomopanied by headaches and convulsions.He had a history of left eye enucleation.His clinical features consisted of left-oriented multi-cranial nerve involvements,CSF white cells and protein slightly increased, abnormal thickening and significantly enhanced of the dura in head MRI, as well as the more typical pathological changes of the dura mater, the treatment of steroid response was well, but relapsed after drug withdrawl, Clinically supporting the diagnosis of HCP. Conclusion The clinical characteristics of the patients as soon as possible to make enhanced head MRI and dural biopsy, early diagnosis and proper treatment the prognosis is good.%目的提高对本病的认识，以减少误诊。方法报道1例肥厚性硬脑膜炎（ HCP ）患者的病史、症状、体征、血和脑脊液实验室检验、影像学（ CT、MRI、SPET）及硬脑膜病理资料，并对治疗反应和1年随访结果进行总结。结果患者男性，61岁，主因两个半月来头晕、耳鸣、吞咽困难、声音嘶哑伴头痛、抽搐入院。既往有眼球摘除史。查体以左侧为主的多组脑神经受累的体征，脑脊液（ CSF）白细胞、蛋白轻度增高，头颅MRI硬脑膜异常增厚和明显强化以及较典型的硬脑膜病理改变，对类固醇激素治疗反应良好，停药后复发特点，支持HCP的诊断。结论临床有本病的症状体征的患者要尽早做强化头颅MRI和硬膜活检，早期诊断和正确的治疗预后较好。