耳源性肥厚性硬脑膜炎伴颞叶水肿及器质性精神障碍一例

时间 : 2009-12-06 22:15:48 来源：lw.jkrj.cn

[摘要]

耳源性肥厚性硬脑膜炎伴颞叶水肿及器质性精神障碍一例,健康人家

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易自翔　张榕　肖文惠中华耳鼻咽喉科杂志2000年第4期第35卷

　　【摘要】　目的　肥厚性硬脑膜炎（hypertrophiccranialpachymeningitis，HCP）属罕见疾病，易被误诊，报告1例耳源性肥厚性硬脑膜炎伴颞叶水肿及器质性精神障碍的病例，希引起共同注意。方法　患者男性，26岁，以右侧剧烈头痛、眩晕、恶心、呕吐、面神经及外展神经麻痹等，于1997年7月入院。磁共振成像及CT检查提示颞骨炎性病变，岩尖硬脑膜及其相邻的小脑幕增厚，明显强化呈条带状。诊断为右侧周围性面瘫、迷路炎、岩尖综合征。手术行面神经减压、迷路切除、乳突及岩锥炎性气房清除、岩尖病变探查等。术后除耳聋以外所有症状消失。术后9个月后，患者出现精神异常，曾住精神病院未获改善。1998年5月13日复查磁共振并增强扫描，发现右中颅窝的硬脑膜及小脑幕增厚，颞叶下极明显水肿，海绵窦壁增厚，包围颈内动脉使之受压变小。结果　耳源性HCP伴颞叶水肿及器质性精神障碍的诊断确定，大剂量青霉素静脉点滴治愈。23个月后随访患者生活工作良好，未见复发。结论　MRI是诊断耳源性HCP的主要手段，抗生素治疗此例HCP有效。

Otogenichypertrophiccranialpachymeningitisassociatedwithedemaofthetemporallobeandorganicmentaldisorder-casereport

YIZixiang，ZHANGRong，XIAOWenhui（DepartmentofOtorhinolaryngologyofFirstAffiliatedHospital,FujianMedicalUniversityandTheOtorhinolaryngologyInstituteofFujianProvince,Fuzhou350005,China）

　　【Abstract】　Objective　Hypertrophiccranialpachymeningitis（HCP）isararediseasewhichmightbemisdiagnosed.Onetypicalcaseofotogenichypertrophiccranialpachymeningitis（HCP）associatedwithedemaofthetemporallobeandorganicmentaldisorderwasreported.LiteraturesassociatedwithHCPwerereviewedforreference.Methods　InJuly,1997,a26-year-oldmanwasadmittedforright-sidedsevereheadache,dizziness,nausea,vomiting,facialandabducensnervepalsy.MRIandCTrevealedinflammationinthetemporalboneandlocallythickenedduramaterwithobviousenhancementasabandinthepetrousapexandnearbytentoriumcerebellum.Thepatientthenunderwentoperationincludingdecompressionofthefacialnerve,labyrinthectomy,anderadicationoftheinflammatorycellsinthemastoidandpetrousportion.Postoperatively,theclinicalsignsdisappearedexcepthearingloss.Sevenmonthslater,thepatientsufferedfrommentaldisorderwithinterruptedexcitementtohitandabusethefamilymembers.Hewasthentreatedinapsychosishospitalbutnoimprovementcouldbeseen.OnMay13,1998,MRIandtheenhancedMRIdemonstrateddiffusethickenedtentoriumcerebellumandduramaterinthemiddlecranialfossa.Theinferiorportionofthetemporallobewasobviousedema.Theinternalcarotidarterywaspartiallyoccludedduetothethickenedwallofcavernoussinus.Results　Hence,thediagnosisofHCPassociatedwithedemaoftemporallobeandorganicmentaldisorderwasestablished.Thepatientwascuredbyhighdosageofpenicillin.Conclusion　MRIisanessentialmethodfordiagnosisofhCP.Antibioticwasaneffectivetreatment.

　　【Keywords】　Duramater；　meningitis，bacterial；　Temporallobe；　Brainedema；　Mentaldisorders；　Otitismedia，suppurative

　　1966年德国人Birkner等［1］首先报告1例硬脑膜出血性硬脑膜炎及硬脑膜下血肿伴广泛钙化的病例。至今各种肥厚性硬脑（脊）膜炎（hypertrophiccranialpachymeningitis，HCP；hypertrophicspinalpachymeningitis，HSP）的有关文献共170篇，其中以日本报告最多。我国毛文萍等［2］1998年曾报告HCP和HSP各1例。硬脑（脊）膜炎包括发生于颅内的HCP和发生于脊髓的HSP，有的患者兼有HCP和HSP。HCP的病因多种多样，涉及多学科。经多方检查，病