误诊为肌萎缩侧索硬化的神经型布氏杆菌病1例并文献复习

doi:10.3969/j.issn.1004-583X.2023.12.008

摘要/Abstract

摘要：

目的探讨神经型布氏杆菌病(Neurobrucellosis,NB)临床特征,诊断及治疗,反思该病例为何误诊为肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS),比较二者之间的共同点及临床工作当中如何鉴别。方法报告1例误诊为ALS的NB患者的临床特点及治疗,结合文献进行归纳总结。结果患者58岁男性,诊断为NB,治疗2周后症状明显好转,右侧近端肢体肌力Ⅴ^-级,远端肌力Ⅳ^-级,左侧近端肌力Ⅴ^-级,左侧远端肌力Ⅴ^-级,双侧腱反射(+++),双侧Babinski征(+)。转回当地继续抗布氏杆菌治疗。结论 NB误诊为ALS的主要原因在于NB症状体征多不典型,表现多样,颅内感染体征不明显,从而误诊为其他神经系统疾病。

关键词: 布鲁杆菌病, 肌萎缩侧索硬化, 周围神经系统疾病

Abstract:

Objective To explore the clinical features, diagnosis and treatment of neurobrucellosis (NB), and to analyze the causes of misdiagnosis of NB as amyotrophic lateral sclerosis (ALS). To compare the common points between NB and ALS and how to identify them in clinical work. Methods The clinical characteristics and treatment of a patient with NB misdiagnosed as ALS were reported and analyzed in combination with literature review. Results A 58-year-old male patient diagnosed with NB had significantly alleviated symptoms after 2 weeks of treatment, with right proximal limb muscle strength of grade Ⅴ^-, distal muscle strength of grade Ⅳ^-, left proximal muscle strength of grade Ⅴ^-, left distal muscle strength of grade Ⅴ^-, bilateral tendon reflexes (+++), and bilateral Babinski's sign (+). He was referred back to the local hospital for continuing anti-Brucella treatment. Conclusion Misdiagnosis of NB as ALS is mainly attributed to the atypical and diverse symptoms and signs of NB, and non-specific signs of intracranial infection, leading to misdiagnosis of other neurological diseases.

Key words: brucellosis, amyotrophic lateral sclerosis, peripheral nervous system disease

中图分类号:

R516.7

春梅, 甄瑾, 晏燕, 刘斌, 李敏, 孙霞. 误诊为肌萎缩侧索硬化的神经型布氏杆菌病1例并文献复习[J]. 临床荟萃, 2023, 38(12): 1101-1106.

Chun Mei, Zhen Jin, Yan Yan, Liu Bin, Li Min, Sun Xia. A case of neurological brucellosis misdiagnosed as amyotrophic lateral sclerosis and literature review[J]. Clinical Focus, 2023, 38(12): 1101-1106.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.12.008

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I12/1101

图/表 7

参考文献 25

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神经	节段	潜伏期(ms)	时限(ms)	波幅(mV)	面积(mVms)	速度(m/s)
左正中神经	腕	5.67	5.63	0.70	2.12
	肘→腕	11.20	8.00	0.31	0.89	38.2
右正中神经	腕	9.92	5.18	0.16	0.62
	肘→腕	19.50	9.80	0.02	0.05	21.4
左尺神经	腕	3.17	4.66	1.48	3.30
	肘下→腕	5.92	5.38	1.12	3.10	58.2
	肘上→肘下	8.92	5.38	0.91	2.82	36.7
右尺神经	腕	4.75	3.92	0.28	0.47
	肘下→腕	8.17	3.13	0.25	0.36	41.00
	肘上→肘下	10.30	3.00	0.24	0.33	53.1
右腓总神经	踝前	4.00	5.75	0.69	1.94
	腓骨小头下→踝前	5.58	5.72	0.67	2.02	37.9
左胫神经	内踝	4.17	4.58	2.04	3.81
	腘窝→内踝	13.60	5.20	1.37	3.45	38.2
右胫神经	内踝	3.92	5.66	1.26	3.19
	腘窝→内踝	12.30	5.90	0.84	1.83	42.00

神经	节段	潜伏期(ms)	时限(ms)	波幅(mV)	面积(mVms)	速度(m/s)
左正中神经	腕	5.67	5.63	0.70	2.12
	肘→腕	11.20	8.00	0.31	0.89	38.2
右正中神经	腕	9.92	5.18	0.16	0.62
	肘→腕	19.50	9.80	0.02	0.05	21.4
左尺神经	腕	3.17	4.66	1.48	3.30
	肘下→腕	5.92	5.38	1.12	3.10	58.2
	肘上→肘下	8.92	5.38	0.91	2.82	36.7
右尺神经	腕	4.75	3.92	0.28	0.47
	肘下→腕	8.17	3.13	0.25	0.36	41.00
	肘上→肘下	10.30	3.00	0.24	0.33	53.1
右腓总神经	踝前	4.00	5.75	0.69	1.94
	腓骨小头下→踝前	5.58	5.72	0.67	2.02	37.9
左胫神经	内踝	4.17	4.58	2.04	3.81
	腘窝→内踝	13.60	5.20	1.37	3.45	38.2
右胫神经	内踝	3.92	5.66	1.26	3.19
	腘窝→内踝	12.30	5.90	0.84	1.83	42.00

神经	刺激部位	记录部位	潜伏期(ms)	时限(ms)	波幅(mV)	面积(mV/ms)	距离(mm)	速度(m/s)
左正中神经	中指	腕	2.50	1.47	2.38	1.70	115	46.00
右正中神经	中指	腕	2.60	1.27	7.36	4.75	120	46.20
左尺神经	小指	腕	1.83	1.24	6.92	4.05	95	51.80
右尺神经	小指	腕	1.93	1.34	9.11	6.75	100	51.70
左腓肠神经	跟骨上14 cm	外踝	2.00	1.30	11.80	7.39	110	55.00
右腓肠神经	跟骨上14 cm	外踝	2.20	1.20	7.97	4.90	130	59.10
右腓浅神经	腓骨长肌	足背	1.97	1.16	12.60	7.53	95	48.30

神经	刺激部位	记录部位	潜伏期(ms)	时限(ms)	波幅(mV)	面积(mV/ms)	距离(mm)	速度(m/s)
左正中神经	中指	腕	2.50	1.47	2.38	1.70	115	46.00
右正中神经	中指	腕	2.60	1.27	7.36	4.75	120	46.20
左尺神经	小指	腕	1.83	1.24	6.92	4.05	95	51.80
右尺神经	小指	腕	1.93	1.34	9.11	6.75	100	51.70
左腓肠神经	跟骨上14 cm	外踝	2.00	1.30	11.80	7.39	110	55.00
右腓肠神经	跟骨上14 cm	外踝	2.20	1.20	7.97	4.90	130	59.10
右腓浅神经	腓骨长肌	足背	1.97	1.16	12.60	7.53	95	48.30

神经	刺激部位	平均潜伏期 (ms)	最短潜伏期 (ms)	最长潜伏期 (ms)	F游标潜伏期 (ms)	F-M潜伏期 (ms)	出现率 (%)
左正中神经	腕	29.6	17.6	35.7	29.6	28.9	60%
右正中神经	腕	31.3	31.3	31.3	31.3	30.6	100%
左尺神经	腕	30.5	30.5	30.5	30.7	30	100%
右尺神经	腕	NA	NA	NA	17.6	16.9	NA
右腓总神经	外踝	NA	NA	NA	19.2	18.5	NA
左胫神经	内踝	41.3	17.6	52.9	48.7	46.2	100%
右胫神经	内踝	47.8	47.8	47.8	47.0	46.1	100%