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病例342:与IgG4相关的超性脑膜炎

Shehbaz Ansari¹, Brian H Mu¹, John Findley²

¹Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612.

|October 28, 2025

概括

一位70岁的妇女经历了严重的中背痛,被诊断出患有不常见的脊髓门关节疾病. 用葡萄糖皮质类药物和修复剂治疗导致症状改善.

科学领域:

神经学神经学
在瘤学瘤学.
免疫学免疫学免疫学

背景情况:

一位70岁的老妇人出现了严重的,渐进的中背痛,对常规止痛药没有反应.
疼痛辐射到下肋骨,随着位置变化而恶化,严重影响日常生活.

研究的目的:

为了调查70岁女性中背部严重疼痛的原因.
为了诊断和管理一个罕见的脊髓膜病的病例.

主要方法:

诊断工作包括腰部穿刺和脑脊液 (CSF) 分析,显示蛋白质升高,葡萄糖轻微降低和淋巴细胞增加.
大脑脊髓液 (CSF) 细胞学和流动细胞测量显示小淋巴细胞没有克隆增殖,并检测到橄克隆带.
脊柱和大脑成像 (CT和MRI) 进行,以及胸部,腹部和骨盆CT扫描.

主要成果:

脑脊液 (CSF) 分析表明,炎症过程中蛋白质和淋巴细胞数量增加.
尽管感染和自身免疫面板呈阴性,但脑脊髓液中存在的小克隆带表明了潜在的免疫介导或瘤过程.
患者接受了T6断层切除术,并开始接受葡萄糖皮质类药物和修复剂治疗.

结论:

这名患者被诊断患有脊髓膜病,这是一种罕见的疾病,会影响脊髓周围的膜.
用葡萄糖皮质激素和修复剂治疗导致症状改善,随访成像证明了这一点.

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