以意识障碍及癫痫持续状态起病的隐球菌性脑膜炎1例并文献复习
Cryptococcal meningitis with onset of consciousness disorders and status epilepticus:a case study and literature review
陆新华 1马赞涛 1刘一兵 1张小鹏1
作者信息
- 1. 前海人寿广州总医院神经外科,广东 广州 513000
- 折叠
摘要
隐球菌性脑膜炎(CM)临床表现缺乏特异性,仔细询问病史和流行病学史是早发现本病的重要基础,腰穿脑脊液墨汁染色涂片可快速、简便明确诊断.意识障碍及癫痫持续状态提示预后不良.本文通过利探讨1例确诊CM患者的临床症状、脑脊液化验及墨汁染色涂片、诊断及治疗情况,以提高神经内外科、重症医学科医生对CM的认识.患者入院后行气管插管呼吸机辅助呼吸,腰穿脑脊液墨汁染色涂片可见隐球菌,脑脊液培养示新型隐球菌.头颅CT未见明显异常.床旁视频脑电监测示双额区持续癫痫样放电,右侧为著.按"CM"抗真菌以及抗癫痫治疗.停用镇静药物患者神志无改善,仍昏迷,行气管切开术.后家属因经济原因返当地医院继续抗真菌治疗.3个月后电话随访,患者死亡,死亡原因考虑脑炎后继发呼吸循环衰竭.
Abstract
Objective To help neurologists,neurosurgeons,and critical care physicians better understand cryptococcal meningitis.Methods The clinical symptoms,cerebrospinal fluid(CSF),ink staining,diagnosis and treatment of a confirmed patient with cryptococcal meningitis were explored.Results After admission,the patient underwent tracheal intubation and assisted breathing with a ventilator.Cryptococcus was detected on the cerebrospinal fluid ink staining smear through lumbar puncture,and the cerebrospinal fluid culture had new Cryptococcus.CT scan showed normal imaging.Video EEG showed sustained epileptic discharge in the bilateral frontal area,especially on the right side.The patient received antifungal and antiepileptic treatment and underwent tracheostomy after sedative drugs were discontinued,but she remained unconscious.For financial reasons,the patient was taken back to a local hospital to continue treatment.Three months later,the patient died due to respiratory and circulatory failure after encephalitis.Conclusions Cryptococcal meningitis has no specific clinical manifestations.Careful examination of medical and epidemiological history is critical to early detection of this disease.Cerebrospinal fluid ink staining smear via lumbar puncture can quickly help diagnose the disease.Consciousness disorders and status epilepticus indicate poor prognosis.
关键词
隐球菌性脑膜炎/意识障碍/癫痫持续状态/真菌感染Key words
Consciousness disorders/Status epilepticus/Cryptococcal meningitis/Fungal infection引用本文复制引用
出版年
2024
NETL
NSTL
万方数据