12例结核性神经根脊髓炎的临床特征及磁共振成像特点分析

doi:10.19983/j.issn.2096-8493.20220045

摘要/Abstract

摘要：

目的总结分析结核性神经根脊髓炎(TBRM)临床特征及磁共振成像特点,提高临床上对TBRM的认识。方法:对河北省胸科医院2015年10月至2021年6月神经内科收治的12例TBRM患者进行回顾性研究,收集患者的一般资料、血常规、血红细胞沉降率、脑脊液压力、脊髓及头颅磁共振表现、CT表现、治疗方案、以及病情转归等资料,分析其临床特征及脊髓核磁共振特点。结果:12例患者中,双下肢麻木无力11例,腰腹部束带感、背痛及瘙痒4例,尿便障碍4例,发热3例;7例合并结核性脑膜炎,6例合并活动性肺结核,1例合并脊柱结核。12例患者血白细胞水平及血中性粒细胞比例均位于正常范围,6例血红细胞沉降率升高,5例进行结核感染T细胞斑点试验结果均阳性。12例患者中,3例脑脊液病原学检测阳性,脑脊液压力正常者11例,脑脊液白细胞升高者10例,脑脊液蛋白升高者10例。脑脊液葡萄糖降低者3例,脑脊液氯化物降低者7例。脑脊液腺苷脱氨酶升高者5例。12例患者脊髓核磁共振表现为脊髓水肿10例、脊髓空洞2例、脊髓膜强化4例。结论:结核性神经根脊髓炎临床罕见,与结核性脑膜炎、肺结核、脊柱结核关系密切,脑脊液以蛋白升高为主,脊髓磁共振成像可表现为脊髓水肿、脊髓空洞及脊膜强化。结核感染后出现的脊髓症状要考虑TBRM的可能性。

关键词: 结核, 中枢神经系统, 脊髓, 磁共振成像

Abstract:

Objective: To summarize and analyze the clinical features and magnetic resonance imaging (MRI) characteristics of tuberculous radiculomyelitis (TBRM). Methods: A retrospective study was conducted on 12 patients with TBRM admitted to the Department of Internal Neurology in Hebei Chest Hospital from October 2015 to June 2021. The general data, blood routine, erythrocyte sedimentation rate (ESR), cerebrospinal fluid (CSF) test results, spinal cord and cranial MRI, lung CT, treatment regimens and prognosis of the patients were collected to analyze their clinical characteristics and spinal cord MRI characteristics. Results: Among the 12 patients, there were 11 cases of numbness and weakness of both lower limbs, 4 cases of lumbar and abdominal girdle sensation, back pain and pruritus, 4 cases of urinary and stool disorders and 3 cases of fever. There were 7 cases with tuberculous meningitis, 6 cases with active pulmonary tuberculosis, and 1 case with spinal tuberculosis. The blood leukocyte level and blood neutrophil ratio in 12 cases were in the normal range, the ESR in 6 cases was increased. and the blood T-SPOT.TB results in 5 cases were positive. CSF testing in 12 patients showed positive pathogenesis in 3 cases, normal pressure in 11 cases, elevated white blood cells in 10 cases, elevated protein in 10 cases, decreased glucose in 3 cases, decreased chloride in 7 cases, and increased adenosine deaminase in 5 cases. The MRI manifestations of spinal cord in 12 patients were spinal cord edema in 10 cases, syringomyelia in 2 cases and spinal cord membrane enhancement in 4 cases. Conclusion: TBRM is clinically rare and is closely related to tuberculous meningitis, pulmonary tuberculosis and spinal tuberculosis. Its CSF is predominantly elevated in protein, and spinal cord MRI can show spinal cord edema, syringomyelia and meningeal enhancement. Therefore, the possibility of TBRM should be considered based on spinal cord symptoms following tuberculosis infection.

Key words: Tuberculosis, Central nervous system, Spinal cord, Magnetic resonance imaging

中图分类号:

R529.3
R741

李军霞, 孟艺哲, 张亚楠, 陈颜强, 赵青. 12例结核性神经根脊髓炎的临床特征及磁共振成像特点分析[J]. 结核与肺部疾病杂志, 2022, 3(4): 296-299. doi: 10.19983/j.issn.2096-8493.20220045

Li Junxia, Meng Yizhe, Zhang Yanan, Chen Yanqiang, Zhao Qing. Clinical features and MRI characteristics of 12 cases of tuberculous radiculomyelitis[J]. Journal of Tuberculosis and Lung Disease, 2022, 3(4): 296-299. doi: 10.19983/j.issn.2096-8493.20220045

图/表 2

表1

图1

参考文献 13

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序号	性别	年龄(岁)	脊髓受累部位	主诉
1	女	38	胸椎4~11脊髓,脊膜	双下肢麻木无力
2	女	43	颈胸段脊髓、脊膜,脊髓空洞症	双下肢麻木无力,脐以下感觉减退
3	男	45	颈胸腰段脊膜	双下肢麻木无力
4	女	47	胸椎5~9脊髓水肿伴脊膜强化	发热,腹部皮肤麻木,双下肢无力,尿便障碍,共济失调
5	男	49	胸椎10~11脊髓	胸背部疼痛,双下肢麻木无力,尿便障碍
6	男	51	胸髓脊髓、脊膜	双下肢无力
7	男	53	胸2-胸11,脊髓空洞	腰背部瘙痒,双下肢无力,尿便障碍
8	男	56	颈胸腰段脊髓	四肢麻木无力,尿便障碍
9	男	56	胸椎10至腰椎1脊髓,脊髓水肿	双下肢麻木无力,共济失调
10	男	60	胸椎8~9脊髓	小便困难,鞍区麻木
11	女	69	胸髓	发热,双下肢无力
12	男	73	胸椎3~8脊膜	发热,意识障碍,双下肢麻木无力,束带感,鞍区麻木

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