以步态不稳为首发症状的新型隐球菌性脑膜脑炎1例

doi:10.3969/j.issn.1004-583X.2023.03.012

临床荟萃 ›› 2023, Vol. 38 ›› Issue (3): 260-263.doi: 10.3969/j.issn.1004-583X.2023.03.012

以步态不稳为首发症状的新型隐球菌性脑膜脑炎1例

王瑶¹^,², 黄鹏如¹, 曾昭豪¹, 罗宏¹, 岑海媚¹, 罗彬¹, 张誉¹()

1.暨南大学附属第一医院神经内科,广东广州 510632
2.广东三九脑科医院神经内三科,广东广州 510510

收稿日期:2021-06-28 出版日期:2023-03-20 发布日期:2023-05-11
通讯作者: 张誉 E-mail:yuzhang2016@jnu.edu.cn
基金资助:
国家自然科学基金资助项目——DYS△45-55基因修复的人脂肪干细胞源性肌肉祖细胞移植DMD模型鼠促进肌肉再生的研究(81801246)

Cryptococcal meningoencephalitis with unstable gait as the initial symptom: A case report

Wang Yao¹^,², Huang Pengru¹, Zeng Zhaohao¹, Luo Hong¹, Cen Haimei¹, Luo Bin¹, Zhang Yu¹()

1. Department of Neurology,the First Affiliated Hospital of Jinan University,Guangzhou 510632,China
2. Third Department of Neurology,Guangdong 999 Brain Hospital,Guangzhou 510510,China

Received:2021-06-28 Online:2023-03-20 Published:2023-05-11
Contact: Zhang Yu E-mail:yuzhang2016@jnu.edu.cn

摘要/Abstract

摘要：

目的探讨以步态不稳为首发症状的新型隐球菌性脑膜脑炎患者的临床特点。方法分析1例以步态不稳为首发症状的新型隐球菌性脑膜脑炎的临床资料。结果 45岁男性,2年前出现步态不稳,进行性加重,并出现记忆力下降、反应迟钝等症状,头颅MR示脑室系统扩张,脑脊液检查发现隐球菌感染,经两性霉素B联合氟胞嘧啶抗真菌治疗后症状改善。结论新型隐球菌性脑膜脑炎起病隐匿,可能以步态不稳为首发症状,临床中应注意排查。

关键词: 脑膜炎, 隐球菌性, 步态不稳, 首发症状

Abstract:

Objective To investigate the clinical characteristics of patients with cryptococcal meningoencephalitis with unstable gait as the initial symptom. Methods The clinical datas of a cryptococcal meningoencephalitis patient with unstable gait as the initial symptom were analyzed.Results A 45-year-old male presented with unstable gait two years ago, and the symptoms worsened progressively, complicated with decreased memory and delayed response. Brain MR scans showed dilation of the ventricular system, and cerebrospinal fluid examination revealed cryptococcal infection. After treatment with amphotericin B and fluorocytosine, the clinical symptoms improved. Conclusion Cryptococcal meningoencephalitis usually has an insidious onset, and unstable gait may be the initial symptom, which should be paid attention in clinical practice.

Key words: meningitis, cryptococcal, unstable gait, initial symptom

中图分类号:

R515.2

王瑶, 黄鹏如, 曾昭豪, 罗宏, 岑海媚, 罗彬, 张誉. 以步态不稳为首发症状的新型隐球菌性脑膜脑炎1例[J]. 临床荟萃, 2023, 38(3): 260-263.

Wang Yao, Huang Pengru, Zeng Zhaohao, Luo Hong, Cen Haimei, Luo Bin, Zhang Yu. Cryptococcal meningoencephalitis with unstable gait as the initial symptom: A case report[J]. Clinical Focus, 2023, 38(3): 260-263.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.03.012

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I3/260

图/表 4

图1 治疗前头颅磁共振 a.双侧侧脑室; b.第三脑室; c.第四脑室

Fig. 1 Brain magnetic resonance imaging before treatment a. bilateral brain ventricles; b. third ventricle; c. fourth ventricle

图2 脑脊液培养出的新型隐球菌(墨汁染色×400)

Fig. 2 Cryptococcus neoformans in cerebrospinal fluid after culturing (ink stain×400)

图3 治疗过程中头颅CT

Fig. 3 Brain CT scans during treatment

表1 治疗过程中腰椎穿刺术结果

Tab. 1 Results of lumbar puncture during treatment

日期	压力 (mmH₂O)	糖 (mmol/L)	氯 (mmol/L)	蛋白 (mg/L)	白细胞 (×10⁶/L)	单个核比例 (%)	红细胞 (×10⁶/L)	隐球菌培养	血糖 (mmol/L)
2020-05-06	145	2.65	109.5	3001	64	94	100	-	9.8
2020-05-15	150	2.48	104.1	2821	14	93	0	+	10.5
2020-05-25	85	2.81	109.3	3265	221	90	100	-	12.8
2020-06-01	78	1.82	121.6	2368	51	99	100	-	6.2
2020-06-08	95	3.36	124.6	2290	10	98	0	-	7.9
2020-06-16	55	3.45	125.8	2126	17	88	100	-	7.2
2020-06-25	测不出	6.97	134.4	1873	23	100	1000	-	21.6

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以步态不稳为首发症状的新型隐球菌性脑膜脑炎1例

Cryptococcal meningoencephalitis with unstable gait as the initial symptom: A case report

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