摘要目的 探讨布鲁杆菌病(简称布病)患者神经系统损伤的临床特点,为临床诊治提供参考.方法 收集吉林大学第一医院2008年10月至2011年9月住院的14例神经型布病患者资料,对其临床表现、病原学、脑脊液检查结果及影像学资料进行回顾性分析.结果 14例神经型布病患者中,临床表现为头痛、呕吐10例,脑膜刺激征11例,烦躁、抽搐2例,淡漠3例,昏迷3例,病理阳性征3例,双下肢无力2例.临床诊断为脑膜炎4例(其中脑膜炎并双下肢瘫痪2例),脑炎2例,脑膜脑炎6例,外展神经麻痹和视力下降各1例,脊髓炎1例,共济失调性步态1例.神经系统损伤均发生于布病急性期,均有发热,采用联合抗感染治疗2～9d,所有患者体温均下降至正常,1～2周后14例患者全部好转出院,1年后随访均恢复良好.结论 布病神经系统损伤临床表现呈多样性;对于长期发热、有神经系统症状患者,应仔细询问病史、流行病史,结合脑脊液及实验室检查,可明确神经型布病的诊断;急性神经型布病早期治疗预后较好.

abstractsObjective To evaluate the clinical features of central nervous system involvement in brucellosis,and to provide references for clinical treatment and diagnosis.Methods A retrospective review was carried out in 14 hospitalized patients who were diagnosed as neurobrucellosis from October 2008 to September 2011 at the First Hospital of Jilin University.Patients' clinical manifestation,pathogen characteristics,cerebrospinal fluid analysis and imaging data were recorded.Results Among the 14 cases of patients with neurobrucellosis,10 cases had the clinical manifestations of headache and vomiting,11 cases meningeal irritation,2 cases dysphoria and seizures,3 cases apathia,3 cases coma,3 cases positive pathological sign,and 2 cases lower extremities weakness.From the perspective of clinical diagnosis of 14 patients with neurobrucellosis,4 cases were meningitis,of which,meningitis with both lower extremities paralysis were 2 cases; encephalitis in 2 cases; meningoencephalitis in 6 cases; abducent paralysis,decreased vision,myelitis and ataxic gait in 1 case,respectively.All patients were in acute phase and had irregular fever.After combination therapy with antibiotics for 2 to 9 days,body temperature of all patients returned to normal,and they were discharged from the hospital after 1 to 2 weeks.All cases were followed up for 12 months,finding no sequelae.Conclusions Due to the diversity of central nervous system involvement in brucellosis,in case of a patient with long-term fever and neurological symptoms,medical and epidemiological history should be inquired and diagnosis would be made easy based on combination of cerebrospinal fluid with laboratory tests.Early treatment of acute neurological brucellosis has showed a good prognosis.