病例334:密码球菌脑膜炎
Maria L Brun-Vergara1, Nader Zakhari1, Carlos H Torres1
1From the Department of Radiology, The Ottawa Hospital-University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9.
Radiology
|February 25, 2025
概括
一名怀孕的患者出现了神经症状,包括头痛,嗜睡和视力变化. 诊断测试显示脑脊液压升高和淋巴细胞多细胞症,这表明有炎症或传染性神经疾病.
科学领域:
- 神经学 神经学
- 产科 产科 产科 产科 产科
- 传染性疾病 传染性疾病
背景情况:
- 一名30岁的孕妇 (25周) 患上了一个月的头痛和两个星期的嗜睡,光恐惧症,双眼视和部疼痛.
- 最初的表现包括 papilledema 和右部神经麻,与正常的头部CT扫描.
- 怀孕没有并发症,患者否认有发烧,最近旅行或相关病史.
研究的目的:
- 为了调查孕妇神经症状进展的原因.
- 要区分传染性,炎症性和其他神经病因.
主要方法:
- 临床检查,包括神经评估和脑下镜.
- 大脑的头骨CT和MRI.
- 腰部穿刺用于脑脊液 (CSF) 分析.
- 进行广泛的血清学和微生物学测试.
主要成果:
- 大脑核磁共振扫描显示了脑下腔和脑上腔的异常.
- 腰部穿刺显示中枢神经液开口压力升高 (32厘米H2O) 和淋巴细胞多细胞症 (136 ×10^6/L总核细胞,59%的淋巴细胞).
- 对传染病原体 (包括真菌菌,病毒和真菌) 和自身免疫性疾病的广泛检查结果是负面的.
结论:
- 患者的表现和诊断结果暗示着炎症或传染性神经系统过程,尽管具体测试是负面的.
- 需要进一步的调查和管理,以确定潜在的原因,并确保母亲和胎儿的福祉.
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